MBDCA Order Form Work Sheet
(Keep this portion for your records)
| Item Identification | Color Choice | Sizes Available | Price for each size |
| Ultra Club 8511 | White, ash, black, blue spruce, crab apple, forest green, graphite, navy, ocean blue, Pacific green, pumpkin, purple majesty, putty, storm blue, wineberry, yellow | M, L, XL XXL, XXXL |
$26 $28 |
| Jerzees 456 | White, sports grey, maize, royal | M, L, XL, XXL | $31 |
| Jerzees 457 | White, birch, black, California blue, forest green, gold, jade, Kelly, light blue, Maroon, Navy, purple, putty, red, royal, sports grey, teal | S, M, L, XL XXL, XXXL |
$20 $21 |
| Topper Totes 801 | Natural, Black, Forest Green, Maroon, Navy, Purple, Red, Roya | N/A | $13 |
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Tear along line and submit the order form below with your check made payable to MBDCA.
Mail to: Linda Lewis, 13884 St Rt 104, Lucasville, OH 45648-8586
| Item Name and Number | Color | Size | Cost each | Total |
| _________________________ | ______________________ | __________ | _________ | ___________ |
| _________________________ | ______________________ | __________ | _________ | ___________ |
| _________________________ | ______________________ | __________ | _________ | ___________ |
| _________________________ | ______________________ | __________ | _________ | ___________ |
| _________________________ | ______________________ | __________ | _________ | ___________ |
| $5.50 for 1 item, $6.50 for 2 items, $7.50 for 3 or more items | Shipping - | ___________ | ||
| Total payable to MBDCA - | ___________ | |||
| Your name and Shipping Address |
| ____________________________________________ |
| ____________________________________________ |
| ____________________________________________ |
| May we please have a telephone number or e-mail in case of a question about your order |
| Phone:____________________ e-mail:___________________________________ |