ORDER FORM PLEIKU AIR BASE ASSOCIATION
PLEASE PRINT CLEARLY
NAME: FIRST___________________________LAST___________________________________ STREET_______________________________________________________________________ CITY_____________________________________________STATE__________ZIP+4_______-____
PHONE WITH AREA CODE:_____________________________________________________
****************************************************************************** BASEBALL CAPS WITH LOGO - QUANTITY ORDERED _________@ $12.00 EACH
SHIRT ORDERS:
TEE SHIRTS: The wives may order also if they wish.
COLOR: NAVY BLUE ______
SMALL TO EXTRA LARGE---------------------------------------------------------------$15.00 TWO FOR.............................................................................................................$25.00
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DECALS AND PATCHES:
PLEIKU AIR BASE ASSOCIATION PATCH .............................................$3.00 OR 2 FOR $5.00
PLEIKU AIR BASE ASSOCIATION DECAL...............................................$2.00
Postage included in price.
TOTAL AMOUNT ENCLOSED----------------------------------------------------------$___________
MAIL TO:
TOM RUSHNOCK
1628 Taylor Avenue
ARNOLD, PA 15068 -4135
MAKE CHECKS PAYABLE TO : Pleiku Air Base Association
Please indicate size and quantity for each item!
THANK YOU. PLEASE ALLOW 3-4 WEEKS FOR DELIVERY