AIRBRUSHED SHIRT ORDER FORM

DESCRIBE OR DRAW DESIGN ON SHIRT TEMPLATE

                                  FRONT (POCKET OPTIONAL)                            BACK

1.  SHIRT TYPE: (CIRCLE ONE)

       T-SHIRT  /  LONG SLEEVE T *($2) /  TANK TOP  /  SWEAT SHIRT *($4)  /  OTHER: ___________

       *ADD $ FOR SELECT STYLES

2.  SHIRT SIZE: (CIRCLE ONE)

       S     M     L     XL   *XXL     OTHER: _________

     *ADD $2 FOR EACH ADDITIONAL SIZE FROM XXL UP.

      CHILDREN'S SIZES AVAILABLE UPON REQUEST

3.  COLOR:  (CIRCLE ONE)

       WHITE / CREAM / LT. GREY / LT. BLUE / *BLUE / *DK. BLUE / *BLACK /

      *RED / *DK. RED / *GREEN / *FOREST GREEN / YELLOW / ORANGE / OTHER: _____________

       *ADD $4 FOR DARK COLORS (BECAUSE MORE WORK IS INVOLVED TO MAKE IMAGE APPEAR)

4.  VEHICLE DESIGN / DESCRIPTION: (PLEASE NOTE LOCATION ON SHIRT)

       MAKE: ___________________   MODEL: ______________________________  YEAR: ___________

       COLOR (S): __________________________________________________________________________

       *VEHICLE ACCESSORIES:____________________________________________________________

      ______________________________________________________________________________________

        *ADDITIONAL COST FOR CUSTOMIZING:  GUIDE:  ADD $2 FOR EACH BASIC ACCESSORIES  - I.E. LIGHTS, WINCH, GRILL GUARD, BUMPERS, ETC.    NO ADDITIONAL COST FOR ANTENNAS, PIN STRIPPING, ETC.  CALL / EMAIL IF YOU HAVE PRICING QUESTIONS.

         FOR BACKGROUNDS AND EXCESSIVE MODIFICATIONS, CONTACT ME FOR DETAILS.

5.  WORDS OR NAMES ON DESIGN: (PLEASE NOTE LOCATION ON SHIRT)

_________________________________________________________________________________________

6.  COMMENTS:   ______________________________________________________________________

7.  PRICING: $35 PER SHIRT (INCLUDES SHIRT, BASIC VEHICLE DESIGN AND NAME)

        *NOTE ANY ADDITIONS TO COST FROM ABOVE:

          _________________________________________________________________________________

8.  SHIPPING:  $4 PER SHIRT

9.  YOUR INFO:    NAME:_______________________________________________________________

    ADDRESS: __________________________________________________________________________

__________________________________________   PHONE: ___________________________________

10.  PAYMENT METHOD:

          CHECK: ____________      MONEY ORDER: ____________        PAYPAL: (ADD $2): ____________

CONTACT INFORMATION:

(336) 434-6076  PLEASE LEAVE A MESSAGE

I WILL RETURN YOUR CALL

E-MAIL: grapeaperanger@yahoo.com

WEBSITE: www.grapeapedesign.com

MAIL FORMS AND

PAYMENT TO:

DEAN SCHIMMENTI

527 WEAVER AVE

HIGH POINT, NC 27263