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| Name |
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| Billing Address |
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| State |
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| City |
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| Zip |
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| Phone |
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| Shipping Address |
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| State |
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| City |
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| Zip |
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| Phone |
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| Mug |
T-Shirt |
Size |
Quantity |
Price Each |
Total Price |
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Subtotal |
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| 6% Sales Tax |
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| Shipping &
Handling ($3 per item) |
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Grand Total |
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| Credit card number |
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| Expiration date |
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Signature _______________________ Date ____________________________
Fax to: 717-854-0100 • Sees-the-Day, Inc. • P.O. Box 3052
• York, PA 17402-0052
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