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Print and complete this T-shirt order form and include it when you send your check or money order for $24.95 (per t-shirt) made payable to The Duchess Fund to:

The Duchess Fund
408 – 14th Street S.W.
Ruskin, FL 33570


Quantity/Size:  Medium __________      Large __________      Extra-Large __________
Name: _________________________________________________________
Address: _______________________________________________________
City, State, Zip Code: ____________________________________________
E-mail Address: __________________________________________________
Phone: _________________________________________________________
Sorry, no credit card orders
Florida Residents add 6.75% Sales Tax – $1.68, total $26.63 (per shirt)
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