Moolah Shrine Gateway 500 Order FormPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeItems to OrderClick on the item(s) you would like to purchase. *Gateway 500 Class A – $42.00Gateway 500 Polo – $40.00Gateway 500 Jacket – $100.00QTY of Class A1123QTY of Gateway 500 Jacket1123QTY of Gateway 500 Polo1123Please note: The following price increases when selecting sizes (Price will reflect the quantity of garments): 2XL and Tall: +$3.00 3XL and Larger: +$5.00 Class A Size *Medium – $0.00Medium – $0.00Large – $0.00X-Large – $0.002XL – $3.003XL – $5.004XL – $5.005XL – $5.00Class A Sizes – QTY 2 *Medium – $0.00Medium – $0.00Large – $0.00X-Large – $0.002XL – $6.003XL – $10.004XL – $10.005XL – $10.00Class A Sizes – QTY 3 *Medium – $0.00Medium – $0.00Large – $0.00X-Large – $0.002XL – $9.003XL – $15.004XL – $15.005XL – $15.00Gateway 500 Jacket Size *Medium – $0.00Medium – $0.00Large – $0.00X-Large – $0.002XL – $3.003XL – $5.004XL – $5.005XL – $5.00Gateway 500 Jacket Size – QTY 2 *Medium – $0.00Medium – $0.00Large – $0.00X-Large – $0.002XL – $6.003XL – $10.004XL – $10.005XL – $10.00Gateway 500 Jacket Sizes – QTY 3 *Medium – $0.00Medium – $0.00Large – $0.00X-Large – $0.002XL – $9.003XL – $15.004XL – $15.005XL – $15.00Gateway 500 Polo Size *Medium – $0.00Medium – $0.00Large – $0.00X-Large – $0.002XL – $3.003XL – $5.004XL – $5.005XL – $5.00Gateway 500 Polo Sizes – QTY 2 *Medium – $0.00Medium – $0.00Large – $0.00X-Large – $0.002XL – $6.003XL – $10.004XL – $10.005XL – $10.00Gateway 500 Polo Sizes – QTY 3 *Medium – $0.00Medium – $0.00Large – $0.00X-Large – $0.002XL – $9.003XL – $15.004XL – $15.005XL – $15.00Name you would like embroidered onto the garment(s). Class A and Special Class A are first name only. *Item Delivery Pickup/Drop Off – $0.00 Shipped – $10.00 Item(s) will be delivered to Moolah Shrine unless Shipping is selected. Item(s) will be delivered to the address listed on the form. Please feel free to contact us to discuss other options.Order TotalTotal$0.00Payment InformationCash payment is only available for Pickup/Drop Off Payment Options *CashCheckCredit CardVenmoYou will not be charged at this time. This is to let us know how to invoice the order.Please mail your check made out to C&M Creative Designs, LLC to: C&M Creative Designs, LLC 541 Long Train Dr Troy, MO 63379 We will email you an invoice to pay by Credit Card to the email you provided above. There will be a 3% processing fee added to the total when using credit card or Venmo Business. We will email you the Venmo information to the email listed above. Date Requested By:We have a normal estimated 3-week turnaround time. If this date you are requesting is before then, we will contact you to discuss.Terms & Conditions *I understand that by clicking submit I am agreeing to purchase the selected items above for the total listed on this pageI understand that there are no refunds on custom itemsSubmit
