Panama Hat Printable Order Form

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.

Press Button to Print 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:
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:
 
The Panama Hat Company of the Pacific dba Brent Black Panama Hats 1314 Center Dr., Suite B-448 Medford, OR 97501 There is no retail store at this address. (more) Toll Free: (888) 658-6500 Phone: (541) 201-3113

Text and photos © 1988-2025, B. Brent Black. All rights reserved.

100% Secure Shopping

We accept PayPal We accept Visa We accept MasterCard We accept AMEX We accept Discover We accept Diners Club We accept JCB
 
 

 

1314 Center Dr., Suite B-448; Medford, OR 97501 Ph: (888) 658-6500 International: +1-541-201-3113 www.BrentBlack.com