Size Qty Ordered Sub Total Small @$12 ea $ Medium @$12 ea

The official 2015 Poteau Balloon Fest T-shirt may be ordered using this form. Poteau businesses have agreed to let their employees purchase
the official Balloon Fest T-shirt at a special pre-event price of $12 each. Poteau businesses will also allow employees to wear the shirts on
Fridays leading up to the event. The last day for pre-event orders will be September 18th, 2015. After the September 18th deadline, the
purchase price for shirts will be $15 each. If you have any other questions please feel free to contact the Poteau Chamber at 918-647-9178!
Size
Small
Medium
Large
X Large
2 XLarge
*3 XLarge
*4 XLarge
*5 XLarge
Qty Ordered
Sub Total
(before 9/18/15)
@$12 ea
@$12 ea
@$12 ea
@$12 ea
@$12 ea
@$12 ea
@$12 ea
@$12 ea
TOTAL DUE
$
$
$
$
$
$
$
$
$
*3X & Up are special order only, we will not order additional shirts in these sizes.
PAYMENT INFORMATION: We can accept Visa, MasterCard or Discover. We can invoice current Chamber Members in good standing only. All other businesses or
individuals who would like to place an order, please pay with a credit card, check or money order for your total amount due.
You may mail this form with payment to the Poteau Balloon Fest, C/O Poteau Chamber of Commerce, 501 South Broadway, Poteau, Oklahoma, 74953 or fax it to 918647-4099.
Please make checks payable to: Poteau Balloon Fest. Prices include tax. If you need your order shipped, please call regarding shipping charges.
(Please make Checks payable to POTEAU BALLOON FEST)
Please Bill Me
I have enclosed Payment
Please charge my Credit Card (Visa, MC or Discover)
_____________________________________________________________________________________________
Billing AddressCity, State, Zip
________________________________________________________________________________________
Contact Phone NumberContact Email Address
Check No: _________
Credit Card Number: _________ ________ ________ ________ Exp. Date: ______/______
____________________________________________
Authorized Signature