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Print Name:________________________________________

Indicate how many for each size you are purchasing

Prices Small thru XL $7.00

pocket add 1.50

for XXL add 2.00

for XXXL add 4.00

Return order form to Gene Stafford or Maureen Olsen.

Or mail to: Route 66 Cruizers

PO Box 102

Kingman AZ. 86402