Northcoast Miata Club

Merchandise Order Form

[FrontPage Save Results Component]

Date Ordered:

Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code

Work Phone
Home Phone
E-mail

Select any of the following options that apply:

Polo Shirt  Fleece Jacket  Hat  Jacket  Sweatshirt

And Select One Logo Style to be embroidered:

   Logo Style 1	         Logo Style 2	Logo Style 3

QTY	SIZE	COLOR	LOGO STYLE	DESCRIPTION

Print completed form and Submit to Mike DePietro, Merchandise Coordinator.

Copyright © 2006 Northcoast Miata Club. All rights reserved.
Revised: September 26, 2006