BSR Merchandise Order Form

Name _______________________________________________

Address _____________________________________________

City, State, Zip ________________________________________

Phone _____________________ Email _____________________________________

Credit Card Number______________________________ Exp. Date ______________

Fax Visa or MasterCard Orders to: 828.859.6390 or Mail to Address Below

Qty	Item Description-please note: ladies, regular or youth cut t-shirts & cap design	Size	Color	Price	Total
	Total

Please be very specific when ordering t-shirts and caps.

*** All prices include Shipping and Handling
*** Use this form for all Merchandise

Send check or money order payable to: Boykin Spaniel Rescue, Inc.,

c/o Allyn Johnson, 100 Glenwalden Circle, Tryon, NC 28782