| Ordered By: (Please Print) |
| Name: |
| Street: |
| City/State: |
| Zip: |
| Quantity: | Pricing: |
| 1-12 | $6.95 Each |
| 13-25 | $5.95 Each |
| 26-50 | $4.95 Each |
| Orders over 50... Prices available upon request. | Prices Include shipping, handling and sales tax. |
| Date of Order: |
| Day Phone - (Area Code): |
| Clip
available in: Neon Yellow, Neon Pink, Neon
Green, White, Yellow, Teal
, Royal Blue or Fuschia Strap available in : Black or White |
| Clip Color Pick One From Above | Strap
Color Pick One From Above | Quantity |
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 | Total Quantity: | · |
| *Price Each: | · | |
| Total: | · | |
| *Quantity Pricing Applies to Total Order | ||