Uniform Order Form
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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
( X )
T-Shirt (Short Sleeve)
$15.19
$
15.19
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Shirt (Long Sleeve)
$18.45
$
18.45
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Red Polo (Short Sleeve, Name/Title/Call Sign)
$18.99
$
18.99
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
White Polo (Short Sleeve, Name/Title)
$18.99
$
18.99
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Black Cap
$8.14
$
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
$
0.00
Back Patch
$13.64
$
13.64
Quantity
1
2
3
4
5
6
7
8
9
10
Chest Patch
$6.32
$
6.32
Quantity
1
2
3
4
5
6
7
8
9
10
Name Tape
$3.25
$
3.25
Quantity
1
2
3
4
5
6
7
8
9
10
Shoulder Patch
$5.00
$
5.00
Quantity
1
2
3
Black T-Shirt (Short Sleeve, Chaplain Only)
$15.19
$
15.19
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Black Shirt (Long Sleeve, Chaplain Only)
$18.45
$
18.45
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Black Jacket
$51.72
$
51.72
Size
S
M
L
XL
XXL
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Commendation Bar - Purple Heart
$7.00
$
7.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Special Requests:
Submit
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