| 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 | |||||||
| Total | |||||||
| Questions contact Donna at donnagobrecht@kevingobrecht.com | |||||||