Jacket Order Form

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Visitor #:
43,234

2010 Chappaqua Lacrosse Jacket Order Form

Players Name: __________________________________________

Address: __________________________________________

Phone Number: __________________________________________

Name/nickname to be on Jacket, max. 13 characters, please print clearly:

____________________________________________________________

Size	Quantity	Cost Each	Total
Youth M		$75.00
Youth L		$75.00
Youth XL		$75.00
Adult XS		$85.00
Adult S		$85.00
Adult M		$85.00
Adult L		$85.00
Adult XL		$85.00
Adult XXL		$85.00
Total

Total amount due: _____________________________________

Received by: _____________________________________

Orders will be placed November 15, 2009, January 29, 2010, and March 26, 2010.
Allow 4 weeks for delivery. Jackets can be purchased for players and or parents.

Please send payment to:
New Castle Lacrosse
P.O. Box 142
Chappaqua, NY 10514

Visitor #: 43,234