Order Form Print this out and mail it to: SYRCL Store, 216 Main Street, Nevada City, CA 95959 OR fax it to: 530.265.6232

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I would like to order the following items from the SYRCL Store:

ITEM DESCRIPTION	QUANTITY	SIZE	PRICE
SUBTOTAL:
Please add a total of $2.00 for postage and handling of items:			$2.00
TOTAL:

Your Name:_________________________________________
Address:____________________________________________
City:________________________State:_______Zip:_________
Phone: (____)________________________
Email:______________________

 I am enclosing a check payable to SYRCL.
 Please charge my credit card:
 Mastercard  Visa
Card #:__________________________________
Exp. Date:_________________
Card Holder Signature:________________________