~~FULLER AND JOHNSON CO. ORDER FORM

NAME:
STREET ADDRESS:
CITY, STATE, ZIP:
PHONE NUMBER/EMAIL:

DONATION* Total_______

DONATIONS* FOR F&J GEAR:

 DECALS (2 FOR $10)
Quantity ______   Total_______

 COFFEE CUP ($15)
Quantity ______   Total_______

 KEY CHAIN ($5):
Quantity ______   Total_______

 TOTE BAG ($25):
Quantity ______   Total_______

 POLO SHIRT ($15)
Quantity ______   Total_______

 T-SHIRTS (BACK LOGO) ($15)
Quantity ______   Total_______

 T-SHIRTS (FRONT LOGO) ($10)
Quantity ______   Total_______

ENGINE LOOKUP:
 Owner: 
 Serial Number:    
 Horsepower:        
 Model:    
Quantity ______   Total_______

Checks payable to:  Fuller and Johnson Co., %Liz Johnson, 353 Blue Heron Drive, Winter Park Florida 32789 OR:  PayPal:  FullerandJohnson@hotmail.com.  Questions:  Call Liz Johnson at 407-947-2579 or email:  FullerandJohnson@hotmail.com    (*TAX DEDUCTABLE, A RECEIPT WILL BE SENT TO YOU)