Mosquito Merchandise Order Form

(Print this page, fill out your order, and mail to address below)

ORDER FORM

DESC

QTY

PRICE

TOTAL

NAME:

  1. Tie-Dyed Dog Tag  

4.00

 

SHIP TO ADDRESS:

  2. Slap-On Reflectors  

4.00

 

(hand delivered when possible)

  3. Sunglasses  

3.00

 

PHONE NUMBER:

  4. Car Window Cling  

2.00

 

PAYMENT METHOD:

Card #: 5. Lanyards  

7.00

 

Cash, check, Visa and MC

Exp Date: 6. Beads  

2.00

 
    7. Team Mosquito Flying Disks  

1.00

 
    8. Team Mosquito Ducks  

3 for 1.00

 
   

Tax (5%)

 
     

S&H - $1.00 per order, 0 for hand delivery

S&H

 

Signature for credit card orders only

    

Total

 

Mail orders to:

Bailey Recognition Products, PO Box 308, Fairfax, IA 52228

or hand deliver to team Mosquito members, Jenny Bailey or Ron Williams.

ALL PROCEEDS BENEFIT MOSQUITO PROJECTS AND EXPENSES.