Women In Canoe Purchase Form Fill in required information and print out this form. We accept checks and money orders. Please write checks payable to “Women In Canoe”
Products to Purchase:
Item Name Price Quantity Subtotals WIC Necklace $15.00/each WIC Bandana $5.00/each WIC Visor $12.00/each WIC Cap $15.00/each Shipping and Handling    1 - 3 items: $5.00    4 - 7 items: $7.50    8 - 11 items: $10.00    12 - 20 items: $15.00 Grand Total:
Ship to:
First Name:
Last Name:
Address Line 1:
Address Line 2:
City/Town:
State:
Zip:
Phone:	- -
Email dbatan@aol.com for mailing instructions of the completed order form and payment or if you have any questions about ordering the WIC products.