PLEASE FILL OUT ORDER FORM COMPLETELY & THEN CLICK PRINT

First Name: Last Name:

Address: (Shipping)

City: State: Zip:

1. Team Shirt: Small Medium Large X-Large XX-Large None 1 @ $20.00 2 @ $40.00 3 @ $60.00 4 @ $80.00 Check Box (New Members & Your First Shirt)

2. Flex Fit Ball Cap: None 1 @ $16.00 2 @ $32.00 3 @ $48.00 4 @ $64.00 5 @ $80.00

3. Hooded Sweat Shirt w/Zipper Front: Small Medium Large X-Large XX-Large None 1 @ $28.00 . 2 @ $56.00 . 3 @ $84.00 . 4 @ $112.00 . 5 @ $140.00 .

4. Oversized Duffle Bag: None 1 @ $27.00 2 @ $54.00 . 3 @ $81.00 4 @ $108.00 . 5 @ $135.00 .

5. Team Jacket: Small Medium Large X-Large XX-Large None 1 @ $53.00 . 2 @ $106.00 . 3 @ $159.00 . 4 @ $212.00 . 5 @ $265.00 .

6. Hand Towel: 1 2 3 4 5 6 7 8 9 10

Method of Payment: Check Money Order Credit Card Type of Credit Card N/A MC VISA DISCOVER

Enter Card Number - - - 3-Digit Security Code (Back of Card)

Expiration Date: - -

All Credit Card Orders MUST Be Mailed To The Address Below.

• MAKE CHECKS PAYABLE TO : Buford Mills LMT.
• MAIL TO:The Body Shop, Massage Therapy - Buford Mills - 6277 Elk Creek Rd. Middletown, OH 45042

Subtotal: Charge

Shipping: Charge Shirt $3.85 Hat $3.85 Hooded Zip $4.00 Duffle Bag $4.00 Jacket $5.00 Towel $ 2.00 EACH ADDITIONAL ITEM PLEASE ADD $2.00

TOTAL AMT : ALL ORDERS NOT SHIPPED UNTIL PAYMENT IS RECIEVED

By checking this box, I hereby authorize the Body Shop Massage Therapy to bill my credit card for the above amount.

Please Allow 2 Weeks Delivery Time (For Items That Are Made To Order)