| 2008/2009 POLAR BEAR RIDE PATCHES & ROCKERS Order Form |
 |
 |
| Main patches ordered: _________ @ $ ______ = $ ____________ traditional or new - circle one 2009 Rockers ordered: _________ @ $ ______ = $ ____________ white or blue background - circle one 2008 Rockers ordered: _________ @ $ ______ = $ ____________ white or blue background - circle one 2007 Rockers ordered: _________ @ $ ______ = $ ____________ white or blue background - circle one TOTAL = $ ____________ |
| Name: ___________________________________ Phone: __________________________ Address: __________________________________ Email: __________________________ City: _________________________ State: _____ Zip: ___________________________ |
| To pay now with PayPal or credit card click here -> |
| Send order form with credit card info, check or money order to: Piper's Enterprises 575 County Rd. 159 Westcliffe, CO 81252 |
| For Visa, MasterCard or Discover payment: Name on Card (if different from above): _____________________________________ Address (if different from above): __________________________________________ City: _________________________ State: ______ Zip: __________________ Credit Card No.: ______ - ______ - ______ - _______ Expiration (mm/yy): ____ / ____ CVV2 (3-digit number on back) _______ |
| questions: Sales@PipersEnterprises.com or call 913-904-0074 |
| Main Patch 1 - 9 = $4.00 10 - 19 = $3.60 20 - 49 = $3.25 50 - 99 = $3.00 2007, 2008 & 2009 Rocker: 1 - 19 = $1.50 20 - 49 = $1.25 50 - 99 = $1.00 |
 |
| To mail in payment print off this page and proceed below |
|
 |
| Contact us for prices on Custom Patches (see sample below). Initial quantity must be at least 25 |
 |