OSPA
STORE - ORDER FORM
(please print and complete form)
|
PATCHES |
QUANTITY REQUESTED |
$3.50 EACH |
TOTAL COST @ $3.50 each |
|
|
First Responder (Limited quantity available) |
|
|
$ |
|
|
EMT-Basic |
|
|
$ |
|
|
EMT-Intermediate |
|
|
$ |
|
|
EMT-Paramedic |
|
|
$ |
|
|
TOTAL |
$ |
|||
|
T-SHIRT |
QUANTITY REQUESTED |
SIZE |
$15 EACH |
|
|
Light Green |
S |
$ |
||
| " " |
M |
$ |
||
| " " |
L |
$ |
||
| " " |
XL |
$ |
||
| " " |
XXL |
$ |
||
| " " | XXXL | $ | ||
|
TOTAL |
$ |
|||
|
T-SHIRT |
QUANTITY REQUESTED |
SIZE |
$15 EACH |
|
|
Oceana - Bluish/Green |
S |
$ |
|
|
|
" " - " " |
M |
$ |
|
|
| " " - " " |
L |
$ |
|
|
| " " - " " |
XL |
$ |
|
|
| " " - " " |
XXL |
$ |
|
|
| " " - " " |
XXXL |
$ |
||
|
TOTAL |
$ |
|||
|
|
|
GRAND TOTAL: |
$ |
|
| Credit Card Information: | ||||
| Type Card: (Visa or Mastercard Only): | ||||
| Name on Card: | ||||
| Card Number: | ||||
| Exp. Date: | ||||
|
SHIP TO:
NAME: __________________________________________
ADDRESS: _______________________________________
_______________________________________
CITY: __________________________________________
STATE: ___________________ ZIP: ________________
PHONE: _________________________________________
E-MAIL: _________________________________________
|
Mail this form, along with the proper payment, to:
OSPA-OEMSA 38954 Proctor Blvd, #357 Sandy, OR 97055 USA |