Cosmosmith Creations

Please print this form, fill it out, and enclose it with your payment to:

Cosmosmith Creations
P.O. Box 346
Los Alamitos, California 90720



T-SHIRTS

QTY          SHIRT DESIGN   COLOR               SIZE         TOTAL

____@ $15 ea ______________ white/black/natural S M L XL XXL $______
____@ $15 ea ______________ white/black/natural S M L XL XXL $______
____@ $15 ea ______________ white/black/natural S M L XL XXL $______
____@ $15 ea ______________ white/black/natural S M L XL XXL $______
____@ $15 ea ______________ white/black/natural S M L XL XXL $______
____@ $15 ea ______________ white/black/natural S M L XL XXL $______


                            TOTAL AMOUNT OF ORDER   $______

          Name:    ________________________________

          Address: ________________________________

          City:    ________________________________

          State:   ___________   Zip: _____________

          Phone:   ________________________________

          Email:   ________________________________

For more information, please contact:

Cosmosmith Creations T-Shirts
P.O. Box 346
Los Alamitos, California 90720