Phone Orders: 1-866-376-1119 / 705-385-2922 Fax Orders: 705-385-8503 Mail Orders: Hill and Gully Riders, Box 1001, Port Sydney Ontario P0B 1L0 CANADA

CLUB MERCHANDISE ORDER FORM
Please fill out this form, print it and fax or mail it to the address above.
| Item	| Size	| Colour #	| Quantity	| Price	| Extension
Micro-Suede Cap	Adult	Navy Blue Black Forest Green Cranberry Beige		$16.95
T-Shirt	S M L XL 2XL 3XL	Navy Blue Black Forest Green Cranberry		$18.95
Sweat Shirt	S M L XL 2XL 3XL	Navy Blue Black Forest Green Cranberry		$39.95
Decal	N/A	N/A		$ 6.00
Sub Total
* If you are a club member take 10% off the sub total price.			* Less 10% Discount
* Shipping:	$4.00 to $25.00 - $4.00 $26.00 to $45.00 - $7.50 $46.00 to $100.00 - $10.00		* Shipping		$4.00 $7.50 $10.00
			PST @ 8%
			GST @ 5%
TOTAL

Cheque/Money Order Visa Card Master Card
Card Number:	Expiry Date:
Name on Card:
Ship To:
Address:
City/Town:	Postal Code:
Phone #:
Signature:

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