Name:
________________________________________
Address:
City:
State:
Postal Code:
Country:
Phone:
Fax Number:
E-mail:
Qty:
Item:
__________
Loretta Holloway T-Shirt • 15.00
( ) M ( ) L ( ) XL
Plus $4.00 Shipping Multiple orders shipped to one address for single shipping charge.Orders from other countries must be paid in US Currency only.
Make checks or money order payable to:Loretta Holloway P.O. Box 594Belton, SC 29627-0594
ALL RIGHTS RESERVED • Copyright 1997 - 2007 by Loretta HollowayWebsite Management and Design: Desktop Enterprises, Inc.