Merchandise Order Form -- Fax to (512) 462-4558

Name: __________ Mailing Address: __________ City, State ZIP: __________ E-Mail Address: __________ Phone Number: (_____)__________

Ordering Information A $3.95 Shipping & handling charge will be added to each order. Texas sales tax of 8.25% will be charged on all orders. Item Size Color Price Quantity Total Birthday T-shirt Child 10-12 / 14-16 Adult S / M / L / XL White only $8.50 ________ ________ "You're Zapped" T-shirt Child 10-12 / 14-16 Adult S / M / L / XL Lime / Violet $11.50 ________ ________ "Don't Worry Be Zappy" T-shirt Child 10-12 / 14-16 Adult S / M / L / XL Lime / Violet / Yellow $11.50 ________ ________ "You're Zapped" Baseball T-shirt Adult S / M / L / XL Grey with Black sleeves only $16.95 ________ ________ "Don't Worry Be Zappy" Baseball T-shirt Adult S / M / L / XL Grey with Black sleeves only $16.95 ________ ________ Hats Medium / Large Red / Black / Bucket $16.95 _______ _______ BlazerBucks Gift Cards $10 / $25 / $50 _______ _______ SubTotal _______ Tax (8.25%) _______ S&H $3.95 TOTAL _______

Credit Card Information for Fax Orders Name on Card: __________ Card Type: __________ Expiration Date: __________ Card Number: __________ Signature __________