100 Years Cub Scout Shirt - ORDER FORM –

Order by 22/4/2016 for delivery by mid July

POLO SHIRT

Size

/

½ Chest

/

Quantity

Size 8 /

40 cm

/
Size10 /

42 cm

/
Size12 / 44 cm
Size14 / 46 cm
Small / 52 cm
Medium / 55 cm
Large / 58 cm
X Large / 62 cm
2XLarge / 65 cm
3XLarge / 71 cm
5XLarge / 79 cm
Postage
1 to 2 shirts $8.00
3 to 4 Shirts $14.00
5 or more postage to be confirmed

ORDER DETAILS

/

Quantity

/

Price

/

Total Price

T’shirt / $30.00 / = $
Pick up from QSC please circle.
If no add postage / YES / NO

Postage & Handling

/ = $

ORDER TOTAL

/ = $

CUSTOMER PAYMENT DETAILS (PLEASE PRINT)

NAME: ______

ADDRESS: ______

POSTCODE: ______PHONE NO: ______

Email______

EFT to Scouts Australia Qld Branch BSB 034 -010 Account 351715 (Please use as a reference (surname plus first Initial) or if paying by credit card please complete the details below Email orders to: including details of direct deposit

Please Debit my / Visa Card / Mastercard
Number / CCV No:
Expiry Date / / / Amount: $ / Cardholders Phone No:
Cardholders Name (Print) / Email address
Cardholders Signature / Date / Receipt No: