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!