Delmarva Fox Squirrel Shirt Order Form
Ms./Mrs./Mr.______________________________________________
Address__________________________________________
City ______________________________________ State _______ Zip _______
Daytime Phone ________________________________________
Email Address _________________________________________
(Note: Please include your email address if you would like to be added to our mailing list.
We will not share your email address with any other party.)
(Please note: Due to changing postage rates, we highly recommend charging your purchases)
Quantity Size Price Total DFS Adult Short-Sleeved T-shirt (charcoal)
Adult: S,M,L,XL;
Add $2 for XXL; Add $5 for XXXL_______ _______ $17.00 $_______ DFS Adult Short-Sleeved T-shirt (light grey)
Child: XS,S,M_______ _______ $13.00 $_______ Merchandise Total $_______ Less 10% Members Only Discount $_______ Subtotal $_______ Orders shipped to MD addresses add 6% Sales Tax $_______ Shipping:
Up to $15 = $4.50
$15.01 to $35.00 = $5.50
$35.01 to $60.00 = $6.50
$60.01 to $100.00 = $7.50
Over $100.00 = $8.50$_______ (Any order greater than the above will be
shipped at actual cost with credit card info)Total Amount Due $_______
Payment Type (Circle One)
Check/Money Order Visa Mastercard
Credit Card Number ________________________________
Exp. Date _______ (mm/yy)
CVV or CSV Number* __________
*CVV or CSV - Please include the three digit (four digit for American Express) card verification number
Signature ____________________________________________
Make checks and money orders payable to Friends of Blackwater
Mail order to Friends of Blackwater, Inc.
P.O. Box 1231, Cambridge, Maryland 21613
Or fax completed order form to 410-221-7738
Or call 410-901-6125 and leave a message to place an order. All calls will be returned.
For additional information, contact Wolf Hehn at Whehn@aol.com
Thank you for your order!