Blind Dog Tshirts

 Fax: (301) 599-1852  Phone: (301) 599-PETS
(Fax and phone for credit card orders only)
Postal mail:  IMOM, Inc.
PO Box 282
Cheltenham, MD 20623

Date: ________________

Name:  ____________________________

Street address: ________________________________

City, State/Province, Zip/Postal Code: ____________________________

Phone: _______________ Email: ___________________

Blind Dog T-Shirts ~ Size and number of each:

Small __  Medium __ Large __X-Large __   @ $18 each = $_______
XX-Large__ @20.00 each=$_________

US Postage add:
1-2 shirts $3.50
3-4 shirts $3.95
More than 4 please email for correct postage
Total for all: $__________ 

I am enclosing a check or money order in US funds ___ (please write Blind Dog T-shirt in the memo area) Please make checks payable to IMOM Inc. 

I would like to use my Visa __ MasterCard __ American Express ___

My card number is:________________________________
Exp. date:_______

Your signature: ___________________________________________________