| Color - Size |
Quantity |
Price |
Subtotal |
| Black Small |
|
$15.00 |
$_____ |
| Black Medium |
|
$15.00 |
$_____ |
| Black Large |
|
$15.00 |
$_____ |
| Black X-Large |
|
$15.00 |
$_____ |
| |
|
|
|
| Navy Blue Small |
|
$15.00 |
$______ |
| Navy Blue Medium |
|
$15.00 |
$______ |
| Navy Blue Large |
|
$15.00 |
$______ |
| Navy Blue X-Large |
|
$15.00 |
$______ |
| |
|
|
Total |
| |
|
|
$______ |
|
| PAYMENT (Please Select) |
___Check payable to Corvette Promotions |
| | __Visa
__MC __Discover __AmExp |
Credit Card #:__________________________
Exp:
__/__/__
Name on Card: ____________________________________________ |
| Mail payment with order form to the address below |
| Mailing Address: |
Phone: |
(361) 853-1171 |
| Corvette Promotions |
Email: |
cooperscollision@aol.com |
| P.O. Box 271280 |
website |
www.corvettechevyexpo.com
|
| Corpus Christi,TX 78427 |
Fax: | 361-289-1905 |
|