Uniform Order Form
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position:
Member (Level 2)
Member (Level 1)
Instructor
Chaplain
My Products
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next
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T-Shirt (Short Sleeve)
$
15.19
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Shirt (Long Sleeve)
$
18.45
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Red Polo (Short Sleeve, Name/Title/Call Sign)
$
18.99
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
White Polo (Short Sleeve, Name/Title)
$
18.99
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Black Cap
$
8.14
Embroidery Add-On
None
Name Only
Star of Life Only
Name + Star of Life
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Back Patch
$
13.64
Quantity
1
2
3
4
5
6
7
8
9
10
Chest Patch
$
6.32
Quantity
1
2
3
4
5
6
7
8
9
10
Name Tape
$
3.25
Quantity
1
2
3
4
5
6
7
8
9
10
Shoulder Patch
$
5.00
Quantity
1
2
3
Black T-Shirt (Short Sleeve, Chaplain Only)
$
15.19
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Black Shirt (Long Sleeve, Chaplain Only)
$
18.45
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Black Jacket
$
51.72
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Commendation Bar - Purple Heart
$
7.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Special Requests:
Submit
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