the USI College Republicans

• We must have this form and payment in hand before shipping
• We accept Checks, Money Orders, Cashiers Checks, Credit Cards, and Debit Cards (Visa, Mastercard, Discover, and American Express)
• When you submit your credit or debit card information, it is encrypted for your privacy
• Send check or money order payment to the address listed on the payment page
• Shipping rates are below; takes at least 5 business days to ship from order date
• Shirt availability determined by inventory, no arrival date guaranteed

Contact Information:

Name

Organization

Your Title

Home Phone

Work Phone

Cell Phone

Shipping Address:

Name/Organization

Address Line 1

[No P.O. Boxes, please]

Address Line 2

City, ST / Zip

Just type in the amount of items you want in each category. If you do not want any of a particular item, leave all of that category blank.

Tshirts

Price of Tshirts

Quantity of each size:

S		M
L		XL
XXL		XXXL

Coffee Mugs

Price of Mugs
Quantity Desired

Stuffed Elephants

Price of Elephants
Quantity Desired

Sockhats

Price of Mugs
Quantity Desired

A. Total Shirt Cost [Multiply the Price and Number of items above]

B. Total Mug Cost [Multiply the Price and Number of items above]

C. Elephant Cost
[Multiply the Price and Number of items above]

D. Total Sockhat Cost
[Multiply the Price and Number of items above]

E. Subtotal (A+B+C+D )

F. Shipping Cost

[Rates Below]

G. Total Order Amount
(E + F)

Select payment situation

*The merchandise will not be sent until payment is processed.

Please describe when you would like/need your merchandise

Any additional instructions, or comments:

Shipping Rates [UPS Ground is the method unless FedEx is cheaper]

Base Charge	$10
Per Item Charge	$1

* We currently ship only to the Continental United States.

[Click here to go to the payment page without sending this form]