the P.U.R.E. band Store - Merchandise Order Form
ITEM	DESCRIPTION	PRICE	QUANTITY	SUBTOTAL
Click For Close-up	Shirt - Size: Small	$ 10.00	0 1 2 3 4 5 6	$
	Shirt - Size: Medium	$ 10.00	0 1 2 3 4 5 6	$
	Shirt - Size: Large	$ 10.00	0 1 2 3 4 5 6	$
	Shirt - Size: X Large	$ 10.00	0 1 2 3 4 5 6	$
	Shirt - Size: XX Large	$ 10.00	0 1 2 3 4 5 6	$
Click For Close-up	CD - P.U.R.E. Live Audio sampler available on Close-up page.	$ 35.00	0 1 2 3 4 5 6 7 8 9	$
Click For Close-up	Cap	$ 19.00	0 1 2 3 4 5 6 7 8 9	$
Click For Close-up	Button (1 1/2")	$ 2.00	0 1 2 3 4 5 6 7 8 9	$
Click For Close-up	Magnet (3")	$ 2.00	0 1 2 3 4 5 6 7 8 9	$
Total				$

Prices Include Tax And Shipping.

Shipping Information

First Name:
Last Name:
Street Address:
City:
State:	Choose State Alabama  Alaska  Arizona  Arkansas  California  Colorado  Connecticut  Delaware  Florida  Georgia  Hawaii  Idaho  Illinois  Indiana  Iowa  Kansas  Kentucky  Louisiana  Maine  Maryland  Massachusetts  Michigan  Minnesota  Mississippi  Missouri  Montana  Nebraska  Nevada  New Hampshire  New Jersey  New Mexico  New York  North Carolina  North Dakota  Ohio  Oklahoma  Oregon  Pennsylvania  Rhode Island  South Carolina  South Dakota  Tennessee  Texas  Utah  Vermont  Virginia  Washington, D.C.  Washington  West Virginia  Wisconsin  Wyoming
Zip:
Email:	(you will be emailed a tracking #)

To order : 1. Complete the form, then click the PRINT button. Some skip step one, but it's recommended to confirm your order.

2. Mail the form with your check or money order payable to :

Jim Sowder

624 Third Street

Herndon, VA. 20170

3. Click the CREATE EMAIL button. This will email us your order so that we can screen out any problems. If your email pops up, click on the "-" on the top right to minimize it, allowing you to click on Send.