PRINT THIS FORM and mail it . . . or
Call, e-mail or FAX us with your orders,
Monday through Friday, 9 a.m. to 3 p.m. EST.

 E-Mail:locotzinc@earthlink.net
Telephone: 239-283-5599
Fax: 239-283-0532
Toll-Free: 1-866-456-2687

T-shirts from LocoT'z Inc.
HURRICANE CHARLEY T-Shirts
Includes $ 2.00 donation to Last Resort Relief Fund

_____ # of   SMALL  size T-Shirts            @  $20.00 = $ _______
color: WHITE _ or BLACK _

_____ # of   MEDIUM  size T-Shirts            @  $20.00 = $ _______
color: WHITE _ or BLACK _

_____ # of   LARGE  size T-Shirts            @  $20.00 = $ _______
color: WHITE _ or BLACK _

_____ # of  EXTRA LARGE size T-Shirts   @ $20.00 = $ _______
color: WHITE _ or BLACK _

_____ # of  XX LARGE size T-Shirts         @ $22.00 = $ _______
color: WHITE _ or BLACK _

_____ # of  XXX LARGE size T-Shirts         @ $22.00 = $ _______
color: WHITE _ or BLACK _

                              Florida Residents add 6% Sales Tax:   _______
(price includes shipping and handling)            TOTAL = $ _______


     ship to:      name: _____________________________

     address: ____________________________________

                       ____________________________________

                          ____________________________________

                      (MASTERCARD or VISA only)
Credit Card # ______________________ exp date ___/___

Name (as it appears on card) _______________________

Card Billing Address: (SAME as shipping address above?) ____ Yes

   ___________________________

   ___________________________

   ___________________________


Make check to:   LocoT'z Inc.

Send Check or Money Order :

LocoT'z Inc.
5576 Doug Taylor Circle
St. James City, FL 33956