ORDER FORM
Merchandise
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_____ WALL POSTER: $25.00

_____ COASTERS - SOLD IN SETS OF 6 : $16.00/set

_____ NOTE CARDS - SOLD IN SETS OF 8 : $12.00/set



Your name: ____________________________________________

Address: _______________________________________________

City: ___________________ State: ______ Zip: _______________

Phone - Day: (_____) _______________ Evening: (_____) _______________

Credit Card Number __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
exp date __ __/__ __

Name as it appears on your credit Card:

______________________________________________

Your Signature: ____________________________________________

Contact Charlotte Steeplechase Association, Inc. by Phone (704) 843-7070 or by Facsimile (704) 843-7556

Charlotte Steeplechase Association, Inc.
112 Somer Street
Waxhaw, NC 28173