T-SHIRT OFFER

COLORS & PRINTS MAY VARYSEE OVER FOR FULL DETAILS.

NAME:____________________________________ADDRESS: __________________________________

_______________________________________POST CODE: _________________________________PHONE: ___________________________________EMAIL:____________________________________CARDHOLDERS NAME: ___________________________CARDHOLDERS SIGNATURE: ________________________VISA MASTERCARD AMOUNT TO BE CHARGED: $7.95CARD NUMBER: / / /

EXPIRATION DATE: /

SECURITY CODE:

ORDER FORMPLEASE READ CAREFULLY

• Complete this original coupon (no copies).• Include proof of purchase (non-returnable).• Include a $7.95 money order or cheque payable to Jarvis Walker for postage & handling.• Send to:Jarvis Walker173 Hankison DriveNewport, NC 28570

Please allow 28 days for delivery. Mail enquiries to address at left. Jarvis Walker is not responsible for lost or misdirected mail.

MEDIUM

LARGE

XLARGE

CHOOSE YOUR SIZE:

Due to stock availability, we cannot guarantee which Jarvis Walker t-shirt design you will receive.

Total Price Total QTY Each Price

Jarvis Walkter T-Shirt 1 $0 $0

Shipping & Handling: $7.95

Total Cost: $7.95