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Maryland Region 2008
Clothing Store Order Form
Please return this form and mail completed order with
 check payable to: USPC - Md. Region
and mail to:

Mickey Skipper
3738 Smiley Lane
Harwood , Maryland 20776

Home Phone (410) 798-1542
Fax call First
E-Mail Mski129247@aol.com

PLEASE PRINT CLEARLY (use additional pages as necessary)
NAME:  DISCIPLINE:
SHIPPING ADDRESS:
             
PHONE NUMBER (include area code):
E-MAIL: PONY CLUB:

Adult
Youth

Description

 Size Color

Price
Each

How
Many 

Total        $$         
                                                                               
                                
                                
                                
             
TOTAL without Shipping   

Shipping Arrangements (check one):  DC: ____  Pick-Up: ____   USPS* ____

SHIPPING INFORMATION*: Shipping "USPS" rather than delivery or pickup service!

add $1.00 per swatch

   

add $3.00 per shirt/pants

  

add $10.00 per saddle pad

  

6/08                                                                                     TOTAL with Shipping