Customer Info.

First Name:	Last Name:
Phone:	St. Address:	Aprt. #:
Country:	City:	State:

Order Info.

Check to Order	Item Name	Price Per.	Shipping	Quantity	Your Total
	Fitted/S2L4/Gold Diggaz Promo Cd	$5.00	$2.00
	Autographed Fitted/S2L4 T-Shirt	$7/$10	$5.00
	Sizes:
	Autograph to:

Grand Total(Including Shipping):

Check Out Questionnaire

1. Did you complete the entire form? YesNo
2. Did you double check your math?(total/grand total/shipping) YesNo
3. Is your order correct?(Shipping Address, Items Ordered) YesNo
4. Is money order filled out properly?YesNo

Make money orders payable to:
Steven Luster
Send to:
20th Street Ballaz
2349 N.20th Street
Milwaukee, WI 53206

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