Merchandise Order Form

To purchase items on this page:

  1. Fill out the form

  2. Press the "Create Printable Order Form" button.

  3. Print the form out

  4. Send check or money order to address below:

Note:
Please fill out separate forms when ordering more than one of the same item of different colors.

ITEM

 QUANTITY SIZE COLOR COST TOTAL
Sweatshirt  

Small
Medium
Large
X-Large
XX-Large

$20.00
each

T-shirt 

Small
Medium
Large
X-Large
 XX-Large

White $10.00
each
Hat  One Size Fits All   $13.00
each
        Subtotal =
        Shipping*  =
        TOTAL =

Send Payment to:

Lightning Jacks Bar and Grill
2801 Mountain Road
Pasadena, MD 21122

* Shipping Cost

$6.00 per Item
 (orders shipped via USPS Ground Delivery)

Shipping Information:

Name:
Street:
City:
State:
Zip:
Optional Contact Information
Tel:
Email:
(Payment by check or money order only.)
Order will be shipped in 4-6 weeks

Prices current as of: January 08, 2008
(prices subject to change without notice)

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