COTNAM'SPORT

Heartland Flag Swim Wear Order Form
Note: All orders are "taxes included"

One piece swim wear up to size 18.. Size = How many ... ? @ $69.00 each

One piece swim wear sizes 18 plus....Size = How many ... ? @ $79.00 each

Athletic Shorts ................................... Size= How many ... ? @ $59,00 each

Total Amount Enclosed .................................................................................................=.00

Additional information below:

Please provide the following information:

Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Home Phone

E-mail

Fill in, print and mail with cheque or money order to: COTNAM'SPORT, P.O. Box 14, Stittsville. Ontario, K2S 1A2
For more information email to: mark_cotnam@cotnamsport.ca

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Home Phone
E-mail