IC3 Planning Team/Staff Shirt Order Form - 2022 Full Name* First Name Last Name Cell Number*Email* Please select Black Polo Shirt StyleMenWomenBlack IC3 Polo Shirt - Select SizePlease select shirt size.Black Polo S - $18.00Black Polo M - $18.00Black Polo L - $18.00Black Polo XL - $18.00Black Polo 2XL - $20.00Black Polo 3XL - $21.00Black Polo 4XL - $22.00Black Polo Shirt - Add QuantityAqua Bling IC3 T-Shirt - Select SizeAqua Bling S - $30.00Aqua Bling M -$30.00Aqua Bling L - $30.00Aqua Bling XL - $30.00Aqua Bling 2XL - $30.00Aqua Bling 3XL - $30.00Aqua Bling - Add QuantityBlack Bling IC3 T-Shirt - Select SizeBlack Bling S - $30.00Black Bling M -$30.00Black Bling L - $30.00Black Bling XL - $30.00Black Bling 2XL - $30.00Black Bling 3XL - $30.00Black Bling - Add QuantityWhite Bling IC3 T-Shirt - Select SizeWhite Bling S - $30.00White Bling M -$30.00White Bling L - $30.00White Bling XL - $30.00White Bling 2XL - $30.00White Bling 3XL - #30.00White Bling - Add QuantityTotal $0.00 Payment InformationBilling Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name
