Seattle Community Network T-Shirt Order Form

Name:_______________________________________ Phone: (___) _____-________

Address:________________________________________________________________

Address:________________________________________________________________

City:______________________________  State/Prov:________________________

Zip/Postal Code:___________________  Country:___________________________

$15.00 donation per Adult Shirt (9.00 is deductible)
$13.00 donation per Child Shirt (9.00 is deductible)
$3.00 shipping for each set of up to 3 shirts for US destinations.
$5.00 shipping for each set of up to 2 shirts for non-US destinations.

                                      Size          Quantity     Amount
                                     
Please make checks payable to:    Child Small      ___________  ________
SCNA
                                  Child Large      ___________  ________

                                  Adult Small      ___________  ________
Mail orders to:
                                  Adult Medium     ___________  ________
SCNA T-Shirts             
P.O. Box 947                      Adult Large      ___________  ________
Seattle, WA  98111-0947
                                  Adult X-Large    ___________  ________

Thanks for helping to support     Adult XX-Large   ___________  ________
Seattle Community Network!!
                                  Adult XXX-Large  ___________  ________

                                  Adult Medium     ___________  ________
                                  Women's TankTop

                                                      Subtotal: ________

                                                      Shipping: ________

                                                Total Donation: ________