Bear Necessities: Wear The Bear Order Form

Buy Direct From Bear Necessities
"Wear The Bear"
Fax Order Form
Please frint out this form, fill in and call or send to Bear Necessities

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Billing Name:____________________________
Address:_______________________________
City:___________________________________
State: __________ Zip Code:_______________
Telephone:______________________________

Shipping Name:____________________________
Address:_________________________________
City:_____________________________________
State: __________ Zip Code:________________
Telephone:_______________________________

Product: Color: Quantity: Price Each: Subtotal:

  Bear Tie   Green   $65

  Bear Tie   Pink   $65

  Bear Tie   Medium Blue   $65

  Bear Tie   Red   $65

  Bear Tie   Blue   $65

  Bear Tie   Yellow   $65

  Bear Mug   Purple   $10

  Bear Mug   Red   $10

  Bear Mug   Yellow   $10

  Bear Pin   Gold   $5

Payment Method:

By Check or Money Order:
Mail this form with payment to:
Bear Necessities Pediatric Cancer Foundation, Inc.
23 W. Hubbard Street, 3rd Floor
Chicago, IL 60610
By Credit Card:
Fax this form with your credit info to 312-836-1284:
Card Type: (circle one) VISA MC
Name on Card_________________________________________
Card #:________________________________ Exp. Date:______
Signature of Authorized Buyer
_________________________________________ Date:_______

Subtotal:

Shipping & Handling:
($7.95 per shipping address)

Overnight Shipping:
($20 per shipping address)

Tax:
(Illinois residents please add 6.25% state tax)

Order Total:

Thank your for supporting Bear Necessities Pediatric Cancer Foundation