Print this Form and mail to address below or Fax to (866) 857-0740


Name ________________________________________
Address ______________________________________

City _________________ State ________ ZIP ________
Phone ________________ E-mail: __________________

Ship to: (if different)
Name ________________________________________
Address ______________________________________

City _________________ State ________ ZIP ________
Phone ____________________

Optional Q & A: What Search Engine or method did you find us?__________________________
What search terms did you use? ____________________________

Style # Quantity Size Cost Sub - Total
         
         
         
    COD charges: $7.00  
    Sub Total  
    TAX (LA Residents only) 9%  
   
Shipping & Handling :   - choose one -
Jackets, Custom E Jerseys   $16.50/jacket,jersey
T-shirts,Caps,Mdse(less than three items)   $11.50
T-shirts,Caps,Mdse(more than three items)   $16.50
 
    TOTAL ORDER  
[ ] check here if total purchases are over $400 and get a FREE Negro League Merchandise GIFT !

Select One: Visa/Mastercard/American Express/Money Order/Check/COD

purchases may be charged to :
Master CardVISA


Card # _________________________ / Exp. Date _________
Signature __________________________________________

Send
Check, Money Order

made payable to:
21st Century Computing, Inc.
Division, Negro League Store
p.o. box 6174
New Orleans, LA 70174
Note: All sales final. Returns items must be in original, unworn/undamaged condition for exchange or store credit only within 10 days.
     

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