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Please total your order (This is a manual process)
Use the space below to list hat color as well as the item and size of each item purchased.
Be sure to include if the item is for a man or a
woman.
Number of Items Purchased
Total Cost of Items Purchased
Shipping Cost:
Enter total amount of
purchase including shipping:
I will submit payment for
this purchase with :
Personal Check*
Credit Card via PayPal
(see PayPal payment instructions below)
*Please make personal check
payable to the Flying Samaritans and mail
Flying Samaritans, Membership
- P.O. Box 13513, Mesa, AZ 85216
Please include a copy of
this form with your check.
Order
will not be processed until payment is received.
Now we need to know who you are:
Name:
Mailing Address:
Phone Number:
(please include area code)
eMail Address:
DON'T FORGET TO HIT THE "SUBMIT" BUTTON BELOW |