Copyright 2007-10 MWDTSA, Inc. All Rights Reserved                                                                                 Website created and donated by Jonathan Wahl

MWDSTA - Courtney T-Shirt Order Form

Name: ___________________________________________
Street Address: ___________________________________________
City: ___________________________   State: _________
ZIP: _________-____
Main Contact Phone: ________________
e-mail: ________________________

DescriptionQuantityPriceTotal

Tan and Black T-Shirt : (other sizes may be available upon request)
Small
 $24.95$
Medium
 $24.95$
Large
 $24.95$
X-Large
 $24.95$
XX-Large
 $24.95$
Total Amount$
6% Sales Tax (if shipped within Georgia)$
Total Due (see below)$
Mail completed order form with check payable to "MWDTSA" to:

MWDTSA c/o Dixie Whitman
PO Box 5864
Canton, GA 30114

email queries may be sent to mwdtsa.dixie@yahoo.com