JDRF Walk - 2009
For questions contact 515-987-1055.
Team/Group Name: _______________________________________________________
Your Name: _____________________________________________________________
Your Address: ___________________________________________________________
City: ______________________________ State: ______________ Zip: ____________
Email: _________________________________ Phone: ( _____ ) ______-___________
Item Unit Price # Ordered Total
1 - 5x7 $10.00 __ _____
5 - 5x7s $35.00___________________
10 - 5x7s $50.00___________________
1 - 8x12 $15.00___________________
Subtotal: _____________
Shipping: + $5.00
Total: ________________
Please make checks payable to Thomas &
Bruce Photography.
Credit card payments
(MC/Visa/Discover accepted) must include all of the following:
Card #
_________________________________________
Exp Date
___________ 3 digit code on back
__________
Billing Street Address
___________________________
Billing Zip Code
______________