Cult of Zzap - Order Form

We prefer checks or money orders. Cash accepted, but not recommended.
Delivery is via US Priority Mail. Please allow 1 to 2 weeks for delivery
(We are in Hawaii).
Item			Size	Quantity	Price Ea	Item Total
T-shirt, black		M			$15.00		__________
T-shirt, black		L			$15.00		__________
T-shirt, black		XL			$15.00		__________
T-shirt, black		XXL			$17.00		__________
Mouse Pad, Gold					$10.00		__________
Hat, Tan & Lite Blue				$10.00		__________
Gift Membership Certificate				 $5.00		__________
							Sub Total	__________
Tax (4.17% HI only)						__________
Shipping & Handling **						__________
							Total	__________

Existing members ***	Member Number:	_________
			E-mail Address:	__________________________

**	$4.00 for first 3 items, $5.00 for 4 to 6 items, $6.00 for 7 to 9 items.
***	If already a member, indicate membership number and e-mail address.

Ship To: (attach separate sheet for multiple shipping addresses or membership certificates)

Name				___________________________________________

Address				___________________________________________

City, State ZIP			___________________________________________

Name 
(On Membership Certificate)	___________________________________________

E-mail Address			___________________________________________
(If none, then write down a secret phrase. Used for confirmation of membership only.)

"	I would like to receive periodic informatiom from Cult of Zzap
(about once every 3 months).
Send Order to:				Order Inquires:
PMB 123					sales@Cult-of-Zzap.org
415 Dairy Rd. Suite E
Kahului, HI 96732-2398