Dr. Desiree Lear T-shirt order form

Print out the following order form and mail in your order to:

Volitar Industries
229 N. Franklin St.
Juneau, AK 99801

Yes, rush me the Dr. Desiree Lear T-shirt.

Choose size: small - medium - large - xlrg

Choose color: black - white

Name: ______________________________________

E-mail: _____________________________________
(please double check spelling)

Company (optional): __________________________

Address: ___________________________________

City: _______________________________________

State: ______________________________________

Country: ____________________________________

Zip: ________________________________________

Phone: (___) ____ - ______

( ) I am enclosing a check or money order for $10. US$ payable to Volitar Industries.

Your Dr. Desiree Lear T-shirt will be shipped via US First Class Mail within 48 hours of payment confirmation.