Merch Order Form
Thank you for supporting the group that will be traveling to Haiti.
If you would like to pay by check or cash, please select 0 on both the sweatshirt and hat option.
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Sweatshirt Color
Please select one option.
Dark Gray Heather
Black Heather
Deep Teal Heather
Sweatshirt Size
Please select one option.
Small
Medium
Large
XLarge
Select Option
Small
Medium
Large
XLarge
Hat Color
Please select one option.
Navy/White
Maroon/Gray
Black
Sweatshirt Payment
1 ($25)
2 ($50)
3 ($75)
4 ($100)
0 (0)
1 ($25)
2 ($50)
3 ($75)
4 ($100)
0 (0)
Amount
Hat Payment
1 ($18)
2 ($36)
3 ($54)
4 ($72)
0 (0)
1 ($18)
2 ($36)
3 ($54)
4 ($72)
0 (0)
Amount
If you are buying more than one sweatshirt or hat and would like them to be in more than one color, please indicate that here.
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
Thank you for supporting the group that will be traveling to Haiti.
If you would like to pay by check or cash, please select 0 on both the sweatshirt and hat option.
×
Please Fix the Following