Please Ship To:
NAME_______________________________________________________________
ADDRESS________________________________________________________
CITY ___________________________ STATE ______ ZIP ________
PHONE ____________________ E-MAIL ______________________
I would like my bracelet(s) personalized with the number of a POWD:
His/Her number is: ________________________________________
I do not know a drug war prisoner personally, but I would like you to engrave the number of a POWD on my bracelet(s). (Check Here)______
Bracelet(s): _________ @$16.95 ea. _________
Engraving: __________ @$3.00 ea. __________
Shipping/Handling: - $2.50 __________________
Washington State residents, add 7.8% sales tax: _________
Check or Money Order; Total Enclosed _________
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