Apparel Order Form

Please complete on-line form to order Polo Shirts or Dress Shirts
Your details will be sent to Chicane who will process accordingly

Black Polo Shirt	Adult $35.00   /  Child $30
Mens	S        M        L       XL        XXL
Womens	8       10      12       14        16
Child	8       10      12       14        16
	(picture to right shows polo shirt style - colour is black)
Black Dress Shirt	$70.00
Mens	S        M        L       XL        XXL
Womens	8       10      12       14        16
Name :
Address:
Email:
Total :	+ $5 Freight Cost (up to 5kg)
Other Notes:	(if you require more than 1 of the same size shirt, please let us know in notes)
Payment Options:	1. Credit Card If you wish to pay by credit card: advise Chicane your credit card details: Card Number, Name on Card, Expiry date and amount to go on credit card. DO NOT include credit card information when you fill out this form. 2. Post your cheque to Chicane Racewear, PO Box 112079, Penrose, Auckland Chicane contact details: Email: info@chicane.co.nz Fax: +64 9 5800561