PRINTABLE USCG ORDER FORM - MAIL IN WITH A CHECK or MONEY ORDER or FAX WITH A CREDIT CARD #
| NAME: | TO :
 |
||
| ADDRESS: APT # | SPUR NAME TAPES | ||
| ADDRESS: | PO BOX 4242 | ||
| CITY: | ST: | ZIP: | WAYNESVILLE, MO 65583 |
| DAY PHONE: | E-MAIL: | FAX (573) 774-6263 PH: 1-800-626-3827 | |
| CREDIT CARD #: Exp date: | SIGNATURE: | ||
| QTY. | ITEMS |
PRINT LAST NAME FOR TAPES |
PRICE |
TOTAL |
| NAME TAPES O.D. | 85¢ EACH | |||
| NAME TAPES DESERT | 85¢ Each | |||
| U.S. COAST GUARD O.D. Tapes | U.S. COAST GUARD |
85¢ Each | ||
| U.S. COAST GUARD DESERT TAPES | U.S. COAST GUARD |
85¢ Each | ||
| PLASTIC NAME PLATES | $2.00 Each | |||
| GORE-TEX JACKET TAPES | $2.00 Each | |||
| HELMET BAND w/ NAME | $5.00 Each | |||
| NAME TAPES - WHITE ON NAVY | $1.50 Each | |||
| U.S. COAST GUARD - WHITE ON NAVY | U.S. COAST GUARD |
$1.50 Each | ||
| DOG TAGS - SILVER SET SETS COME WITH: 2- TAGS 2- CHAINS 2-SILENCERS |
LAST NAME: | SILVER $6.00 SET | ||
| FIRST NAME: | ||||
| SS #: | ||||
| BLACK $7.00 SET | ||||
| BLOOD TYPE: | ||||
| USCG Gas Mask Size: xs, s, m, l, xl | ||||
| RELIG. PREF: | ||||
1 |
SHIPPING |
CIRCLE: 1ST CLASS ($3.00) 2nd Day Air UPS ($11.00) |
$3 or $11 |
|
| TOTAL | (All orders will be charged $3.00 for shipping if left blank.) |
TOTAL |