| Item Name | Main Color |
Secondary Color | Price |
| Monograming or Customizing on the above item
(Please underline the last name) | Price |
| Subtotal Of Items and Customizing: | Shipping & Handling (10% of total order with $5.00 minimum): |
| FL Residents Please Add 7% Levy County Sales Tax: |
| Total: |
| Card Number & Type: | Experation Date: |
| Signature: | |
| Name: | |
| Day Phone: | Home Phone: |
| Address: | |
| City,State & Zip: | |
| Ship To: |
| Address: |
| City,State & Zip: |