PCRIA Polo Shirt Order Form
Please print, complete and mail the following form along with your donation to PCRIA, PO Box 661164, Birmingham, AL 35266.
Name:________________________________________________________
Title:_________________________________________________________
Company:_____________________________________________________
Address:______________________________________________________
City:_________________________________________________________
State:_______________ Zip:_______________ Phone:__________________
Email:________________________________________________________
| QTY | Size / Description | Price Each | Extended Price |
| S - PCRIA Polo | |||
| M - PCRIA Polo | |||
| L - PCRIA Polo | |||
| XL - PCRIA Polo | |||
| 2X - PCRIA Polo | |||
| 3X - PCRIA Polo | |||
| 4X - PCRIA Polo | |||
| PCRIA Hat | |||
| Sub-Total | $ | ||
| Shipping & Handling | $ | ||
| Total Enclosed | $ |
Thank you for your donation.