XALTJC Order Form
XALTJC Ministries
111 Parker Rd

Covington, GA 30014
(678) 591-6418

xaltjc@xaltjc.com

Bill To: Name _________________________ Address _______________________ Address _______________________ City _____________ St __ Zip ______ Phone ( ___ ) ____ - _____ Ext _____ Email __________________________

Ship To: Name _________________________ Address _______________________ Address _______________________ City _____________ St __ Zip ______

Item #	Description (specify size if ordering a t-shirt)	Qty		Unit Price	Total
Shipping fees: 1-3 items $3.50 4-7 items $5.00 8-10 items $6.00 Please make checks or money orders payable to Ryan Richardson. Please call or e-mail with any questions.			Item Total
			Shipping Fee
			Grand Total