POLKARIOTY PRODUCTS ORDER FORM

*required
fields

Shipping & handling FREE
w/ orders of 3 or more!
Please email
polkarioty@yahoo.com
for bulk order rates
(include quantity desired)

Polkarioty Product

Price

Quantity

S&H

Subtotal

Adult

Youth

Adult

Youth

Embroidered Cap - Single Flame

$12.00

N/A

$1.75

Embroidered Cap - Double Flame

$12.00

N/A

$1.75

T-Shirt - SMALL

$20.00

$18.00

$1.75

T-Shirt - MEDIUM

$20.00

$18.00

$1.75

T-Shirt - LARGE

$20.00

$18.00

$1.75

T-Shirt - XL

$20.00

$18.00

$1.75

T-Shirt - XXL

$23.00

N/A

$1.75

T-Shirt - XXXL

$23.00

N/A

$1.75

Long Sleeve T-Shirt - SMALL

$25.00

$23.00

$1.75

Long Sleeve T-Shirt - MEDIUM

$25.00

$23.00

$1.75

Long Sleeve T-Shirt - LARGE

$25.00

$23.00

$1.75

Long Sleeve T-Shirt - XL

$25.00

$23.00

$1.75

Long Sleeve T-Shirt - XXL

$28.00

N/A

$1.75

Long Sleeve T-Shirt - XXXL

$28.00

N/A

$1.75

Polkarioty Jacket - SMALL

$150.00

N/A

$3.50

Polkarioty Jacket - MEDIUM

$150.00

N/A

$3.50

Polkarioty Jacket - LARGE

$150.00

N/A

$3.50

Polkarioty Jacket - X-LARGE

$150.00

N/A

$3.50

I have enclosed a check or money order for a total of $________

JACKET ORDERS:
Name exactly as you would like it to appear: (Please Print)
Name #1_________________________Size:________
Name #2_________________________Size:________
Name #3_________________________Size:________
All names are embroidered in script.

Polkarioty Products Order Form
print this page ~ complete this form ~ mail it along with your check or money order
*payable to RY Productions* to:
RY Productions ~ N10060 Fisher Ave. ~ Willard, WI 54493
(Please allow 2-3 weeks for delivery)
Additional information regarding any of the products listed below can be obtained by
calling Rich at 715-267-3275 or you can email him at ryproductions@tds.net