Flatbush Food Coop T-shirt Order Form

To order your T-shirt(s), please print, fill out this form, and mail or fax it to us at:

Coop T-Shirt Offer, Flatbush Food Coop, 1318 Cortelyou Road, Brooklyn, NY 11226-5604

Fax: (718) 284-9719

We're unable to accept Internet or phone orders, sorry.

If you can't print this order form, that's okay. Just write up the necessary information from below and mail or fax it to us. Please write legibly! Thanks.

 ____________________________________________________________________
|                                                                    |
| Name: ________________________________________  Date: ___/___/___  |
|                                                                    |
| Street: ______________________________________  Apt. No. ________  |
|                                                                    |
| City: _____________________________  State ___  Zip: ______-_____  |
|                                                                    |
| Day Phone: (   ) ____-______  E-mail: ___________________________  |
|--------------------------------------------------------------------|
|   T-shirt Color   |  T-shirt Size   |       |  Price   |           |
|  (Please circle)  | (Please circle) |  Qty. |   Each   |   Total   |
|-------------------|-----------------|-------|----------|-----------|
|   Black    Navy   |   S  M  L  XL   |       |  $ 10.99 | $    .    |
|-------------------|-----------------|-------|----------|-----------|
|   Black    Navy   |   S  M  L  XL   |       |  $ 10.99 | $    .    |
|-------------------|-----------------|-------|----------|-----------|
|   Black    Navy   |   S  M  L  XL   |       |  $ 10.99 | $    .    |
|-------------------|-----------------|-------|----------|-----------|
|   Black    Navy   |   S  M  L  XL   |       |  $ 10.99 | $    .    |
|-------------------|-----------------|-------|----------|-----------|
|   Black    Navy   |   S  M  L  XL   |       |  $ 10.99 | $    .    |
|-------------------|-----------------|-------|----------|-----------|
|   Black    Navy   |   S  M  L  XL   |       |  $ 10.99 | $    .    |
|--------------------------------------------------------|-----------|
|    Quantity Discount:   |          Total for T-shirts  | $    .    |
|  10% off 5 or more T's  |------------------------------|-----------|
|-------------------------| - quantity discount, if any  | $    .    |
| Priority Mail shipping  |------------------------------|-----------|
| to anywhere in the U.S. |           + shipping charge  | $    .    |
| (Sorry, no int'l orders)|------------------------------|-----------|
| 1 - 3 shirts, add $3.75 |       TOTAL AMOUNT ENCLOSED  | $    .    |
| 4 - 7 shirts, add $6.60 |------------------------------------------| 
|   8 or more, add $10.50 | Payment by:  ( ) Check   ( ) Money Order |
|-------------------------'              ( ) Visa    ( ) MasterCard  |
|                                                                    |  
| Card #: |_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|  Exp. Date: |_|_|/|_|_|  | 
|                                                                    |   
| Name on card: __________________________________________________   |
|                                                                    |
| Cardholder's Sig.: ____________________________   Date: __/__/__   |
|--------------------------------------------------------------------|
| Special Instructions.  If any color or size substitutions are okay |
| in the event of an out-of-stock situation, please state them here: |
|                                                                    |
| __________________________________________________________________ | 
| We'd appreciate if you could tell us how you found our Web site:   |
|                                                                    |
|____________________________________________________________________|