Negro League Store Fax and Mail-in Order Form

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 :

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.