GET GRIPS

The Clumsy People's Cup

Buy one now for only

$17.69

Colors vary from : Red, Orange, Green, Blue, Purple, Black, White
Fill out following information and
Mail to : 10473 Cypress Highway .S, LA, Jefferson
Or
Email info to: GetGripsSource@gmail.com
Name:______________________ , ____________________
( Last ).
( First )
Phone # : _________-__________-____________

Leave Address Below:

_____
___________
ST.
CITY

____________________ _______
STREET ADDRESS
Apt #

________________
Postal Code
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Color: _________________________
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Form Of Payment ( Circle) :
Credit
Cash
If Cash:
Amount Enclosed: $ ______._____
If Credit:
Card # : _____________________
Expiration Date:________/________
(Month) (Year)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Date: ______/______/_______
Signature: ______________________________