Professional Homecare Providers

Fundraiser Order Form

 

Name:_________________________________________________

 

Address:_______________________________________________

 

City:____________________ State:_______ Zip:_______

 

Phone:_(___)____________________       

 

Prices:   Hoodies                                 $30.00   (Item # 1)

               Long Sleeve Shirts               $17.00   (Item # 2)
               T-shirts                                  $15.00   (Item # 3)
               Canvas Bags - Small           $10.00   (Item # 4)
               Canvas Bags - Large           $20.00   (Item # 5)

               Shipping                                 $3.00 per item or $4.50 for 3 items or more

 

Shirt Sizes:  Sm, Med, Lg, XL, XXL, XXXL,  (Add $2.00 for each XXXL item)

Shirt Colors Available:  White, Gray, Tan

Logos Available:  RN  Registered Nurse, Crinkle Cut   (Logo # 101)
                                RN Registered Nurse, Regular          (Logo # 102)     
                                I Care, RN                                             (Logo # 103)
                                LPN, Literally Perfect Nurse              (Logo # 104)
                                Nurses Call the Shots                         (Logo # 105)
                                Nurses are Patient People                 (Logo # 106)

 

Item No

Size

Color

Logo No

Price

         
         
         
         
         
         
         
     

Shipping

 
     

Total

 

 

 Please make checks payable to PHP and mail this form to:

Melissa Wright, RN

1723 New York Ave.

Manitowoc, WI  54220

 
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