"A Night for Light" T-shirt Order Form
Name:______________________________________________________________
Address:_____________________________________________________________
Phone Number:_____________________ E-mail address:_____________________________
X-SMALL _____ @ $10
SMALL _____ @ $10
MEDIUM _____@ $10
LARGE _____ @ $10
X-LARGE _____ @ $10
2XL _____ @ $10
TOTAL: _____ @ $10 = ____________ + $2.50 (shipping - if shirt(s) mailed to you)
I would like to:
____ pick up my shirt(s) at concert ____have my shirt(s) mailed to me (please check one)
PAYMENT: ___CHECK ___CREDIT CARD TOTAL AMOUNT: _________
________________________________ ______________________________
Credit Card Number Name on Credit Card
_________ ____________ _______________________________________
Exp. Date Security Code Card Holder's Signature
Please mail completed form to:
Plugged In
146 Warren Street
Needham, MA 02492
(make checks payable to Plugged In)
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