Dirty Old Shirt Order Form 

 

Please Print this Form out and Send to:

 

Dirty Old Shirt

Attn: Orders

5600 Greens Drive

Allentown, PA 18106

 

**Make check/money order payable to D.O.S. Inc.

 

Name:_____________________________________

Address:__________________________________

___________________________________________

City:____________ State:_______Zip:_________

Phone:____________________________________

Email Address:____________________________

(used to contact in case of a question concerning order)

 

(Auction winners paying by check/money order, put Auction # in Item # column.)

 

Item Name

Gender

Size

Color

Qty

Price Each

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBTOTAL

 

Shipping & Handling*

 

 

 

S & H*

 

Total Price

Shipping Charges

 

 

 

TOTAL

 

$0.01 - $9.99

$4.95

 

 

 

 

 

$10.00 - $49.99

$7.95

 

 

 

 

 

$50.00 - $99.99

$10.95

 

 

 

 

 

$100.00 - $199.99

$13.95

 

 

 

 

 

$200.00 +

Free

 

 

 

 

 

 

(All Mail Orders will be shipped US Priority Mail)

-If you need it shipped faster, contact D.O.S. at contactus@dirtyoldshirt.com before you send order form.