WATAI General Store Order Form

Print this order form, fill out all information, and mail to the address stated below with your payment.

Contact Information:

First Name:	Last Name:	Middle Initial:
Mailing Address:
City:	State/Province:	Postal Code:
Company Name:
Are you a WATAI Member? (Please circle)	YES	NO
Email Address:
Phone:	Fax:	Other:

Payment Information:

Merchandise	Quantity	Price	Total
Long Sleeve Logo Shirt	X	m-xl $23; xxl $25; xxxl $27	$
Logo Mug	X	$2 each	$
Logo Baseball Hat	X	$10 each	$
Logo Traffic Vest	X	$30 each	$
2003 Bus Testing CD	X	$50 (non members); $10 (members)	$
2002 Car-Pedestrian CD	X	$50 (non members); $5 (members)	$
Shipping (Please contact WATAI for shipping charges prior to ordering):
TOTAL ORDER:			$

Payment Type:

Pay By Check:

Check #:

Amount: $

Instructions:
Mail this application along with your paymentto the following address: