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T SHIRT ORDER FORM

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					                               T SHIRT ORDER FORM

Name__________________________________________________________


Address________________________________________________________


City_________________________ State________ Zip Code___________


Telephone or IP Number____________________ (circle one: Voice or TTY or VP)


Email address_________________________________


T Shirt Size (write the number of shirts you want next to the size)

         ___S      ___M        ___L ___ XXL ___ XXXL


Donation Amount        $__________________ (circle one: check money order cash)


Delivery (check one)      ___Mail to my home        ___Pick up at the GACHI Office


(If mailed add shipping cost of $__3.50___)


Today’s Date___________

                                      RECEIPT

Received From ______________________ T shirt donation of______________

On this day___________________________

T shirt will be (circle one)      Mailed       or      Picked up at GACHI Office

				
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posted:10/9/2011
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