Bushwhackers Order Form

Please fill in the following information, then press the "Submit" button at the bottom. There are also instructions at the end of this form if you prefer to send a check or would rather fax your credit card information.

Please provide the following contact information:

Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Work Phone

Home Phone

E-mail

Please type in the quantity of the following products you want to order:

QTY DESCRIPTION

Baseball Cap (black): $7.00

(SPECIAL) Shirt (black) AND Cap: $19.00

Bushwhackers Shirt (black): $15.00

Bushwhackers/IAW Shirt (white): $15.00

Autographed picture (color): $6.00

Autographed picture (black & white): $4.00

Enter what you
want written on
your autographed
picture:

BILLING

Credit card

Cardholder name

Card number

Expiration date

...or you may Fax a copy of this form to:
to (727)577-2799

To mail
check or
money
order,
send
to-->
WrestlingClassics.com Video Store
Attn: The Bushwhackers
P.O. Box 21094
St. Petersburg, FL 33742-1094

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
E-mail

QTY	DESCRIPTION
	Baseball Cap (black): $7.00
	(SPECIAL) Shirt (black) AND Cap: $19.00
	Bushwhackers Shirt (black): $15.00
	Bushwhackers/IAW Shirt (white): $15.00
	Autographed picture (color): $6.00
	Autographed picture (black & white): $4.00
Enter what you want written on your autographed picture:

	BILLING
Credit card
Cardholder name
Card number
Expiration date
	...or you may Fax a copy of this form to: to (727)577-2799
To mail check or money order, send to-->	WrestlingClassics.com Video Store Attn: The Bushwhackers P.O. Box 21094 St. Petersburg, FL 33742-1094

Bushwhackers Order Form

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