Brie's Bits Order Form

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Please print and fill out this form and send it with your check or money order to:
Brie's Bits
607 E. Antigo
Stamps, AR 71860
email: briesbits@mail.com

NAME__________________________________________ EMAIL___________________________
STREET/P.O. BOX______________________________________________________________________
CITY________________________________________ STATE_________ ZIP CODE_______________
SIZE (please mark with an ‘X’ in the blank beside desired size and print.):
EXTRA SMALL_______ SMALL_______ MEDIUM_______
LARGE_______ EXTRA LARGE_______ XX-LARGE_______
PRINT:
BLACK/RED CHECK_______ U.S. FLAG_______ CAMOFLAGE_______
CAMO W/ FLAG PATCH_______ DENIM_______ SOUTHWEST_______
CHILI PEPPERS_______ YELLOW DOG BONE_______ SNOOPY SOCCER_______
JOHN DEERE_______ BUMBLEBEE_______
SPECIAL INSTRUCTIONS:
PLEASE LIST HERE ANYTHING EXTRA YOU WANT (BUTTONS, PATCHES, ETC.) AND WE WILL
EMAIL YOU TO LET YOU KNOW IF IT’S POSSIBLE OR NOT.
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