State or Canadian Province Contacts

Date*

Your FIRST & LAST name (so we know WHO to ship the order to):*

Address (street, city, state, ZIP). Needed so we know WHERE to ship your order!*

Email Address (in case we must contact you about this order)*

Phone number (in case we need to contact you about this order):*

To place your order, enter the QUANTITY of packages in the quantity field, not the dollar value.

ASSORTMENT

Package 1: (Assortment) 2 wristbands, 1 auto window decal & 5 postcards. A retail value of $11.25 for only a $10 donation!

Price: $10.00 Quantity:

WRISTBANDS

Important If you are ordering Wristbands, be sure to tell us if you would like some of the larger and/or some of the smaller sizes included in your order.

Include some of the Larger sizes in my order
Include some of the Smaller sizes in my order
Include All Sizes in my order

Package 2: 10 wristbands. A retail value of $42.50 for a $20 donation!

Price: $20.00 Quantity:

Package 3: 25 wristbands. A retail value of $106.25 for a $40 donation!

Price: $40.00 Quantity:

Package 4: 50 wristbands. A retail value of $212.50 for a $60 donation!

Price: $60.00 Quantity:

Auto Window Decals

Package 5: 5 Auto Window Decals. A retail value of $25 for a $15 donation!

Price: $15.00 Quantity:

Package 6: 10 Auto Window Decals. A retail value of $50 for a $25 donation!

Price: $25.00 Quantity:

Package 7: 25 Auto Window Decals. A retail value of $125 for a $60 donation!

Price: $60.00 Quantity:

POSTCARDS

Package 8: 10 Postcards for a $5 donation.

Price: $5.00 Quantity:

Package 9: 25 postcards for a $10 donation.

Price: $10.00 Quantity:

Package 10: 50 postcards for a $20 donation.

Price: $20.00 Quantity:

Postage to USA addresses is included. Postage to CANADA is $5. Please put a "1" in the quantity field if using a Canadian address.

Price: $5.00 Quantity:

Postage to non-USA and non-Canadian addresses is $10. Please put a "1" in the quantity field for these shipments.

Price: $10.00 Quantity:

Place any comments or instructions here. If you need to order a product mix not shown on this form, contact Barb VanHerreweghe by email at: barbsoft@rochester.rr.com

Donation Amount (in case you want to make a donation). Enter the dollar amount you want to donate.

This is the total amount of your order:

$0.00

After tapping the SUBMIT button, you will be taken to PayPal to complete the transaction, paying with either your credit card or your PayPal account. After tapping the SUBMIT button, please allow some time for the transfer to PayPal to occur.

Has any of your information changed?

Other Pricing

TAM Product Sales

ASSORTMENT

WRISTBANDS

Auto Window Decals

POSTCARDS

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