shirt order

Duchess Fund Home Page

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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