Florida Jim Order Form

Print this page, complete in pen, and mail with check to

Jim Kaus, 2520 McCormick Road, Southport Florida, 32409

(Return to Home)

Qty

Item

Each

 Total

 

Trick Hat (Specify)

 

 

 

 

 

 

  Polo Shirt - State which one, color and size

 

 

 

 

 

 

 

Tee Shirt - State which one, color and size

 

 

 

 

 

 

Western Belt Buckle (describe)

 

 

 

 

 

 

 

 

 

Cup

 

 

 

 

 

 

License Plate (describe)

 

 

 

 

 

Lapel Pin #________

 

 

 

 

 

One Side Photo Dog Tag

 

 

Two Sided Photo Dog Tag

 

 

 

 

Sub total

 

 

 

Florida Residents add 6% Sales Tax

 

 

 

Add $5.00  Shipping and Handling

5.00 

 

 

 

 

 

 

 

 

 

 

Total

 

 

Special Instructions - Include size of shirts, lettering desired

on hats, cups, and other remarks: 

 

 

 

 

Name: _____________________________________________

Address____________________________________________

City, State __________________________________________

Zip____________

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