Printable Order Form

You can type in the information in this form and then print it out for ordering by fax or mail. None of the data you enter is sent over the Internet—you can even print it out blank and fill it out by hand if you wish. If you prefer to use our secure online ordering system, please click on the order link next to each hat style.

Please type in this information and then print and mail (or fax) this page.

	Ordered By
Name:
Company:
Address:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Email:

	Ship To (if different than address above)
Name:
Company:
Address:
Address:
City:
State:
Zip:
Country:
Phone:
Shipping Instructions:

	Credit Card Information:
Please charge my:	Visa MasterCard American Express JCB Check Enclosed or Money Order Enclosed
Card Number:
Expiration Date:
CVC/CVV:

Remove

Add Hat

	Hat Information
Style Name:
Price:	details
Head Measurement:	details
Ribbon:	see choices
Sweatband:	see choices
Other Instructions:

	Gift Information
Gift Card:	None Gift Card Christmas Gift Card
To:
Gift Message:

	Other Instructions
Comments or Instructions:

3215 Chandler Egan Dr.; Medford, OR 97504 Ph: (888) 658-6500 International: +1-541-201-3113 www.BrentBlack.com