Please Print & Fill Out Form and Return with Check / Money Order to the Following Address:
D.S.I. Motorsports Apparel Sales
Attn: Jack Sullivan
83 South Broadview
Greenbrier, Arkansas 72058
Please Make Checks/Money Orders Payable to: Jack Sullivan
| NAME:(Please Print)______________________________________________________________ |
| ADDRESS:______________________________________________________________________ |
| CITY:________________________________________STATE_________ZIP:_______________ |
| DAYTIME PHONE:________________________EVENING PHONE______________________ |
| EMAIL ADDRESS:_______________________________________________________________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL $ |
| 2007 White Jack Sullivan Logo T-Shirts - Made by ASI Racewear | |||
Youth Medium |
$15.00 each | __________ | __________ |
Youth Large |
$15.00 each | __________ | __________ |
Size Small |
$20.00 each | __________ | __________ |
Size Medium |
$20.00 each | __________ | __________ |
Size Large |
$20.00 each | __________ | __________ |
Size XL |
$20.00 each | __________ | __________ |
Size 2XL |
$22.00 each | __________ | __________ |
| Size 3XL |
$22.00 each | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL $ |
| 2007 White Jack Sullivan Car T-Shirts - Made by New Vision Graphics | |||
Youth Medium |
$15.00 each | __________ | __________ |
Youth Large |
$15.00 each | __________ | __________ |
Size Small |
$20.00 each | __________ | __________ |
Size Medium |
$20.00 each | __________ | __________ |
Size Large |
$20.00 each | __________ | __________ |
Size XL |
$20.00 each | __________ | __________ |
Size 2XL |
$22.00 each | __________ | __________ |
| Size 3XL |
$22.00 each | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL $ |
| 2007 White Jack Sullivan Women's Tank Tops | |||
Size Small |
$15.00 each | __________ | __________ |
Size Medium |
$15.00 each | __________ | __________ |
Size Large |
$15.00 each | __________ | __________ |
Size XL |
$15.00 each | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL $ |
Large #18 Window Decal |
$8.00 each | __________ | __________ |
Small #18 Window Decal |
$6.00 each | __________ | __________ |
D.S.I. Motorsports Window Decal |
$6.00 each | __________ | __________ |
| Please Add $7.00 S&H to your Amount Totals | $7.00 |
| Please Add all Total Amounts + Shipping & Handling | __________ |