CENTRAL STATES ASSOCIATION OF SHRINE MOTOR CORPS

SHIRT ORDER FORM

SHIRT # 69990  $35.00 each (add $2.00 for XXL)

Logo Cuff Cool Weave

Quantity
Black Forest Tartan/Red Putty Navy White Black SELECT COLOR Maize/Yellow     Color
Select Size Medium Large X Large XX Large add $2.00 Size   
  Unit Name 

Add $4.00 per name Enter Name(s) separate with a semi-colon (;)

All Shirts come with the CSASMC WING EMBLEM.
Unit Name to be sewn on Left Sleeve
Member Names to be sewn on Right Chest

Add $4.00 for each name per shirt (example: Jim Tracy)
Add $4.00 for each unit name per shirt (example: Gateway 500 Mini-Indy's)

Make Check payable to:

Bradley Waite
Sec. - Treas. CSASMC
926 South 41st Street
Omaha, NE  68105

If you have any questions, please feel free to call at 402-346-0659 or 402-346-6211