Please mail this form to: Donna Gobrecht
419 Deerfield Drive
Hanover, PA 17331
             
Make checks payable to Kevin Gobrecht Memorial Fund
Merchandise will be sent to address on check unless noted otherwise
Quantity Description price total
     
  G-Man Hat         $15.00  
  G-Man Sticker         $3.00  
  Koozies  

$3.00 or 2@$5.00

 
  G-Man Shirt Adult Small - 4XL $20.00  
Memorial Photo & Fact Sheet $1.00  
  shipping add $2.00 for orders less than $10.00
  add $5.00 for orders $10.00 or more plus $5.40 per shirt  
       
  Customer Name      
  Phone Number      
  Email      
Total
  Questions contact Donna at donnagobrecht@kevingobrecht.com