Stonewall Jackson Ships Store Order Form
	Shirts (click for details)			Color	Size	Cost Each	Mail Cost Ea	Qty	Total
	Long Sleeve Denim			xxxx	XL	$31.00	$4.00
	Long Sleeve Denim			xxxx	XXL	$33.00	$4.00
	Golf Shirt - Short Sleeve			Blue	XL	$27.00	$3.00
	Golf Shirt - Short Sleeve			Black	XL	$27.00	$3.00
	Golf Shirt - Short Sleeve			Blue	XXL	$29.00	$3.00
	Golf Shirt - Short Sleeve			Black	XXL	$29.00	$3.00
	Commemorative Coin					Cost Each	Mail Cost Ea	Qty	Total
				xxxx	xxxx	$12.00	$3.00
	Hats (click for details)					Cost Each	Mail Cost Ea	Qty	Total
	Silver Dolphins			xxxx	xxxx	$12.00	$1.00
	Gold Dolphins			xxxx	xxxx	$12.00	$1.00
	Patches and Pins					Cost Each	Mail Cost Ea	Qty	Total
	Ship's Patch			xxxx	xxxx	$12.00	$1.00
	Ship's Patch Lapel Pin			xxxx	xxxx	$12.00	$1.00
P   P						Grand Total      $_____________
L   R	Name:
E    I						Check Number              __________________
A   N	Street:
S    T						Make checks payable to SSBN634 Association.  Write SJ Store Order in the Memo Line.    Mail To:
E	City:                                       State          Zip:
						Steve Benz
	Phone:                                  E-Mail					4390 NW Shelley Dr.
						Silverdale, WA 98383