SWB STUDIOS ORDER FORM          WESTERN STATES COBRA BASH SPECIAL ORDER
 
Fax or mail to:   SWB Studios,  24966 Via Larga,  Laguna Niguel, CA  92677 
Phone and Fax:  949-249-2264  
 
SHIPPING INFORMATION
NAME ______________________________________________________________________
 
ADDRESS ___________________________________________________________________
 
CITY _________________________________ STATE ___________ ZIP CODE  ___________
 
PHONE ___________________________
PAYMENT METHOD
[_]  CHECK OR MONEY ORDER
PAYABLE TO: SWB STUDIOS
 
VISA, MASTERCARD or AMERICAN EXPRESS (please circle one)
 
CARD NUMBER       __  __  __  __     __  __  __  __     __  __  __  __     __  __  __  __
 
EXPIRES __  __ / __  __ / __ __ __ __          SIGNATURE ___________________________
 
QTY                DESCRIPTION                      SIZE           PRICE        TOTAL
 
_______         COBRA BASH EVENT SHIRT   SMALL             $20.00             $______._____  
 
_______         COBRA BASH EVENT SHIRT   MEDIUM           $20.00            $______._____  
 
_______         COBRA BASH EV SOLD OUT  LARGE             $20.00             $______._____  
   
_______         COBRA BASH EV SOLD OUT  XLARGE           $22.00             $______._____  
 
_______         COBRA BASH EVENT SHIRT   XXLARGE         $22.00             $______._____  
 
_______         COBRA BASH EV SOLD OUT  XXXLARGE       $22.00             $______._____  
 
_______         COBRA BASH EV SOLD OUT  XXXXLARGE      $22.00             $______._____  
 
                                                                          Merchandise Total           $ ______._____
 
                                                                     Shipping and Handling         $______._____
 
                                                                                   Order Total          $______._____
SHIPPING AND HANDLING RATES
ORDER AMOUNT      SHIPPING COSTS
$ 0.00      -   $20.00               $ 5.00
 20.01      -     40.00                  6.00
 40.01      -     60.00                  8.00
 60.01      -   100.00                10.00               
100.01 and up     Please call for rates