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| 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 | ||||||||||||||