Head First Order Form

Head First Foundation Order Form
Fill out and print this page, then please fax/mail to:
314-773-1008
Head First Foundation
3965 Park Avenue, Fifth Floor
St. Louis, MO 63110

Name:

Street Address:

City: State: Zip/Postal Code: Country:

Phone:
E-Mail:

Method Of Payment:
Visa MasterCard Amex Discover Check or money order.

Credit Card Number:
- - - Expiration Date:

Name on Card (exactly):

Head First Logo T-Shirt:
Quantity:

Tango Power T-Shirt:
Quantity:

Head First Team T-Shirt:
Quantity:

Running Man T-Shirt:
Quantity: Black White

Hats: Quantity:

Misc. Merchandise: Head First Water Bottle / $5.00 Quantity:
Tango Poster / $2.50 Quantity:
HIP-D Poster / $2.50 Quantity:

Shipping:
Order Total:
Up to $30.00 = $4.95
$30.01 to $60.00 = $5.95
$60.01 and over = $7.95

Total Charge:

Make checks payable to: Head First Foundation

Head First Foundation Order Form Fill out and print this page, then please fax/mail to: 314-773-1008 Head First Foundation 3965 Park Avenue, Fifth Floor St. Louis, MO 63110
Name:
Street Address:
City:	State: Zip/Postal Code: Country:
Phone:	E-Mail:
Method Of Payment:	Visa MasterCard Amex Discover Check or money order.
Credit Card Number:	- - - Expiration Date:
Name on Card (exactly):
Head First Logo T-Shirt:	Quantity:
Tango Power T-Shirt:	Quantity:
Head First Team T-Shirt:	Quantity:
Running Man T-Shirt:	Quantity: Black White
Hats:	Quantity:
Misc. Merchandise:	Head First Water Bottle / $5.00 Quantity: Tango Poster / $2.50 Quantity: HIP-D Poster / $2.50 Quantity:
Shipping:	Order Total: Up to $30.00 = $4.95 $30.01 to $60.00 = $5.95 $60.01 and over = $7.95
Total Charge:
Make checks payable to: Head First Foundation