2012 Merchandise Order Form

Please complete and submit the form on this website.
If you are having trouble doing so, please fax this form to Torch Run Liaison at 505-856-0346.

All Fields are required in the Personal Information and Additional Questions sections of this form. If it does not apply, please type none or select N/A. Thank you.

Personal Information
First Name:
Middle Initial:
Last Name:
Home Email:
Work Email:
Primary Email:	Home Work
Dept./Agency/Organization:
Street Address (no POB's):
City:
State:
Zip:
Home Phone:
Mobile Phone:
Work Phone:

INVOICE

Qty	Description	Size	Price	Amount
	T-Shirt	S	$	$
	T-Shirt	M	$	$
	T-Shirt	L	$	$
	T-Shirt	XL	$	$
	T-Shirt	XXL	$	$
	T-Shirt	XXXL	$	$
	Torch Run Pin		$	$
		(Torch Pin sells for $3.00 each or 2 pins for $5.00)

	Decal		$	$
	Wristbands		$	$
	Paper Torch Icons		$	$
	Brochures		NC	NC
	Posters		NC	NC
			Grand Total	$
NC = Not Charge