BSR Merchandise Order Form

Name _______________________________________________

Address _____________________________________________

City, State, Zip ________________________________________

Phone _____________________ Email _____________________________________

Credit Card Number______________________________ Exp. Date ______________

Fax Visa or MasterCard Orders to: 828.859.6390 or Mail to Address Below

Qty	Item Description	Size	Color	Price	Total
	Total shipping for any quantity of “green bags” $5.00
	Total

Please be very specific when ordering t-shirts and caps.

*** All prices include Shipping and Handling, except for the “green bags.”
*** Use this form for all Merchandise

Send check, money order (payable to BSR) or credit card information to:

Boykin Spaniel Rescue, Inc.,

c/o Allyn Johnson

100 Glenwalden Circle

Tryon, NC 28782