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: ___________________________________________________