West Gippsland Inc. Shop Company Your Name: * Your Email: * Your Contact Number: * Note for Hoodies: Please select one size larger than you are normally. For example... If your size is normally L, go one size up to XL. Optional Second Email: Aberfeldy Track T-Shirt (1) select colour Khaki $20 Black $20 Orange $20 Aberfeldy Track T-Shirt (2) select colour Khaki $20 Black $20 Orange $20 Aberfeldy Track T-Shirt (3) select colour Khaki $20 Black $20 Orange $20 Shirt Size (1) select size XS S M L XL 2XL 3XL 4XL Shirt Size (2) select size XS S M L XL 2XL 3XL 4XL Shirt Size (3) select size XS S M L XL 2XL 3XL 4XL Shirt Quantity (1) select quantity 1 2 3 4 5 Shirt Quantity (2) select quantity 1 2 3 4 5 Shirt Quantity (3) select quantity 1 2 3 4 5 Aberfeldy Track Hoodie (dark gray/brown only) $45 (a) select size S M L XL 2XL 3XL Aberfeldy Track Hoodie (dark gray/brown only) $45 (b) select size S M L XL 2XL 3XL Aberfeldy Track Hoodie (dark gray/brown only) $45 (c) select size S M L XL 2XL 3XL Hoodie Quantity (a) select quantity 1 2 3 4 5 Hoodie Quantity (b) select quantity 1 2 3 4 5 Hoodie Quantity (c) select quantity 1 2 3 4 5 select number of Aberfeldy Track Stickers (price of stickers inc. postage) 3 - $5 6 - $10 9 - $15 12 - $20 15 - $25 18 - $30 21 - $35 24 - $40 Postal Address: (inc. postcode and state) Payment Options: Please Select Visa or Mastercard Cheque or Money Order Direct Debit Credit Card Number: Expiry Date CCV Number Name on Card: TOTAL AMOUNT (plus postage for shirts/ hoodies capped at $15 total no matter how many you purchase) Please type in this box any requests, comments or questions you may have. Post to: West Gippsland Inc. 10 Little Acre Close, Langwarrin Vic, 3910. Or Fax your form to (03) 9776 6798 or Telephone 0428 534 102. Or Direct Debit: Account Name: West Gippsland Inc. BSB: 033 138 Account Number: 571 827
