ECG T-Shirt Mail-In Order Form
Print - Fill Out - Mail In

• 2007 ECG Club Ash Gray T-Shirt:
•  
• Send me _______ Medium @ $19.00
• Send me _______ Large @ $19.00
• Send me _______ X-Large @ $19.00
• Send me _______ XX-Large @ $21.00
• *Canadian orders add $5.00 Per Shirt
•  
• $ ____________ Total Cost of T-Shirts
• *All Prices include shipping

Total: _______________

Please allow 2 weeks for shipping.

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Name: _____________________________________________________________

Address: _____________________________________

City: ______________________________________________________________

State: _______________________________________ Zip Code: _____________

Mailing Address (if different): ___________________________________________

Phone (Days): ____________________ Phone (Eves): ______________________

e-mail Address: _____________________________________________________

Special Instructions:__________________________________________________

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Select Payment Type:

Check Type: ____Cashiers ____ Money Order ____ Certified ____Personal Check
Check Number: __________________
(personal checks need to clear our bank before order is shipped)
Make checks payable to: East Coast Gassers

Mail Payment & Order Form To:
EAST COAST GASSERS
210 DORCHESTER DRIVE
SELLERSVILLE, PA.18960

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