Order Form

<body stylesrc="indexold.htm" background="homeback.jpg"> <p><a name="Top of Page"></a></p> <div align="left"> <table border="0" width="600"> <tr> <td><img border="0" src="nteeslogo.gif" width="600" height="159"> <p align="center"><b><font face="Arial" size="3"><a href="bodyhome.htm">Home</a>  <a href="bodyaboutus.htm" target="_top">About Us</a>  <a href="bodywhatisfibro.htm" target="_top">What is Fibromyalgia? </a> </font></b><font face="Arial" size="3"><b><a href="bodyfibromitestory.htm" target="_top">A Fibromite's Story<br> </a>  <a href="bodypoem.htm" target="_top">Poems From The Heart</a></b></font>  <a href="bodytees.htm" target="_top"><font face="Arial" size="3"><b>Fibro-Tees </b></font></a><b><font face="Arial" size="3"> </font></b><font face="Arial" size="3"><b><a href="http://fp.geocities.com//nationalitees/_vti_bin/shtml.exe/bodyorder.htm">Order Form</a></b></font><b><font face="Arial" size="3">  </font></b><a href="mailto:fibrotees@yahoo.com"><font face="Arial" size="3"><b>E-Mail Us</b></font></a><font face="Arial" size="3"><b>  <a href="bodylinks.htm" target="_top">Fibro-Links</a>  <a href="bodydisclaimer.htm" target="_top">Disclaimer</a></b></font></p> <div align="left"> <table border="0" width="600"> <tr> <td> <p align="center"><b><font face="Arial" size="6">Nationali<font color="#FF0000">TEES</font> Co. Inc.<br> </font><font face="Arial" size="3">P.O. Box 342 ~ Syracuse, Indiana  46567<br> E-Mail: <a href="mailto:fibrotees@yahoo.com">fibrotees@yahoo.com<br> <br> </a>Purchase Order - Fibro Tees<br> </font> </b> <p align="center"><b><font face="Arial" size="4">Sizes Available - Pricing:</font></b> <div align="left"> <table border="0" width="600"> <tr> <td width="235"><font face="Arial" size="4"><b>Adult Small-Extra Large<br> 2X<br> 3X<br> 4X</b></font></td> <td width="235" valign="top"> <p align="center"><font face="Arial" size="4"><b>$12.00<br> $12.50<br> $13.00<br> $14.00</b></font></td> </tr> </table> </div> <p align="center"><b><font face="Arial" size="3">SHIPPING & HANDLING:</font></b></p> <p align="center"><b><font face="Arial" size="3">$3.00 (First Class) for the first tee <br> $3.50 (Priority) for the first tee</font></b></p> <p align="center"><b><font face="Arial" size="3">$.75 for eachfibrotees@earthlink.net additional tee ordered after the first</font></b></p> <p align="center"><font face="Arial" size="3"><b>Orders with 5 or more tees will have lower shipping &<br> handling charges.  Please <a href="mailto:">E-Mail us</a> for more information! </b> </font> </p> <div align="center"> <center><pre><b><font face="Arial" size="3">Please enter all information onto the order form, then print this page and mail the form and your check or money order to the address at the <a href="#Top of Page">top of the page.</a></font></b></pre> </center> </div> <div align="center"> <center><pre><b><font face="Arial" size="3">- Or -</font></b></pre> </center> </div> <div align="center"> <center><pre><b><font face="Arial" size="3">Enter all information onto the order form, print the page for your records, then click the "Submit" button below, and your order will be processed. Your tees will be promptly shipped when we receive your check or money order, mailed to the address at the <a href="#Top of Page">top of the page.</a></font></b></pre> </center> </div> <div align="center"> <center><pre><b><font face="Arial" size="3">** Canada Residents **</font></b></pre> </center> </div> <div align="center"> <center> <pre><font face="Arial" size="3"><b>Please mail a post office money order in U.S. Funds. There is no extra cost for shipping and handling!</b></font></pre> </center> </div> <script Language="JavaScript" Type="text/javascript"></script><form method="POST" name="FrontPage_Form1" action="_vti_bin/shtml.exe/orderform.htm" onsubmit="return FrontPage_Form1_Validator(this)" language="JavaScript" webbot-action="--WEBBOT-SELF--"> <input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"> <div align="left"> <table border="0" width="470"> <tr> <td width="170"><b><font face="Arial" size="3">Ship-To Name</font></b></td> <td width="300"><input type="text" name="name" size="35"></td> </tr> <tr> <td width="170"><b><font face="Arial" size="3">Street Address</font></b></td> <td width="300"><input type="text" name="streetaddress" size="35"></td> </tr> <tr> <td width="170"><b><font face="Arial" size="3">City</font></b></td> <td width="300"><input type="text" name="city" size="20"></td> </tr> <tr> <td width="170"><b><font face="Arial" size="3">State</font></b></td> <td width="300"><input type="text" name="state" size="10"></td> </tr> <tr> <td width="170"><b><font face="Arial" size="3">Zip</font></b></td> <td width="300"><input type="text" name="zipcode" size="10"></td> </tr> <tr> <td width="170"><b><font face="Arial" size="3">Telephone No.</font></b></td> <td width="300"><b><font face="Arial">(</font></b><input type="text" name="phoneareacode" size="3" maxlength="3"><b><font face="Arial">)</font></b><font face="Arial" size="3"><b><input type="text" name="phone" size="3" maxlength="3"></b>-<input type="text" name="telephone2" size="4" maxlength="4"></font></td> </tr> </table> </div> <p align="center"><b><font face="Arial" size="2"><br> *100% Cotton Tees available in Large and X-Large Only<br> While Supplies Last!</font></b></p> <div align="left"> <table border="1" width="600" style="font-family: Arial; font-size: 12pt; font-weight: bold"> <tr> <td width="60" style="font-size: 10pt; font-family: Arial; font-weight: bold" valign="middle" align="center">Quantity</td> <td style="font-size: 10pt; font-family: Arial; font-weight: bold" valign="middle" align="center" width="100">Fibro Fog/Dragon</td> <td style="font-size: 10pt; font-family: Arial; font-weight: bold" valign="middle" align="center" width="50">Size</td> <td style="font-size: 10pt; font-family: Arial; font-weight: bold" valign="middle" align="center" width="90">50/50 or 100% Cotton*</td> <td style="font-size: 10pt; font-family: Arial; font-weight: bold" valign="middle" align="center" width="90">Total</td> </tr> <tr> <td width="60" valign="middle" align="center"><input type="text" name="Quantity1" size="3"></td> <td valign="middle" align="center" width="100"><select size="1" name="type1" style="font-family: Arial; font-size: 8pt"> <option selected>Choose One</option> <option>Fibro Fog Tee</option> <option>Dragon Within Tee</option> </select></td> <td valign="middle" align="center" width="50"><select size="1" name="size1" style="font-family: Arial; font-size: 8pt"> <option selected>Choose One</option> <option>Small</option> <option>Medium</option> <option>Large</option> <option>X-Large</option> <option>2X</option> <option>3X</option> <option>4X</option> </select></td> <td valign="middle" align="center" width="90"><select size="1" name="cottontype1" style="font-family: Arial; font-size: 8pt"> <option selected>Choose One</option> <option>50/50</option> <option>100%</option> </select></td> <td valign="middle" align="center" width="90"><input type="text" name="teetotal1" size="10"></td> </tr> <tr> <td width="60" valign="middle" align="center"><input type="text" name="Quantity2" size="3"></td> <td valign="middle" align="center" width="100"><select size="1" name="type2" style="font-family: Arial; font-size: 8pt"> <option selected>Choose One</option> <option>Fibro Fog Tee</option> <option>Dragon Within Tee</option> </select></td> <td valign="middle" align="center" width="50"><select size="1" name="size2" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>Small</option> <option>Medium</option> <option>Large</option> <option>X-Large</option> <option>2X</option> <option>3X</option> <option>4X</option> </select></td> <td valign="middle" align="center" width="90"><select size="1" name="cottontype2" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>50/50</option> <option>100%</option> </select></td> <td valign="middle" align="center" width="90"><input type="text" name="teetotal2" size="10"></td> </tr> <tr> <td width="60" valign="middle" align="center"><input type="text" name="Quantity3" size="3"></td> <td valign="middle" align="center" width="100"><select size="1" name="type3" style="font-family: Arial; font-size: 8pt"> <option selected>Choose One</option> <option>Fibro Fog Tee</option> <option>Dragon Within Tee</option> </select></td> <td valign="middle" align="center" width="50"><select size="1" name="size3" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>Small</option> <option>Medium</option> <option>Large</option> <option>X-Large</option> <option>2X</option> <option>3X</option> <option>4X</option> </select></td> <td valign="middle" align="center" width="90"><select size="1" name="cottontype3" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>50/50</option> <option>100%</option> </select></td> <td valign="middle" align="center" width="90"><input type="text" name="teetotal3" size="10"></td> </tr> <tr> <td width="60" valign="middle" align="center"><input type="text" name="Quantity4" size="3"></td> <td valign="middle" align="center" width="100"><select size="1" name="type4" style="font-family: Arial; font-size: 8pt"> <option selected>Choose One</option> <option>Fibro Fog Tee</option> <option>Dragon Within Tee</option> </select></td> <td valign="middle" align="center" width="50"><select size="1" name="size4" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>Small</option> <option>Medium</option> <option>Large</option> <option>X-Large</option> <option>2X</option> <option>3X</option> <option>4X</option> </select></td> <td valign="middle" align="center" width="90"><select size="1" name="cottontype4" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>50/50</option> <option>100%</option> </select></td> <td valign="middle" align="center" width="90"><input type="text" name="teetotal4" size="10"></td> </tr> <tr> <td width="60" valign="middle" align="center"><input type="text" name="Quantity5" size="3"></td> <td valign="middle" align="center" width="100"><select size="1" name="type5" style="font-family: Arial; font-size: 8pt"> <option selected>Choose One</option> <option>Fibro Fog Tee</option> <option>Dragon Within Tee</option> </select></td> <td valign="middle" align="center" width="50"><select size="1" name="size5" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>Small</option> <option>Medium</option> <option>Large</option> <option>X-Large</option> <option>2X</option> <option>3X</option> <option>4X</option> </select></td> <td valign="middle" align="center" width="90"><select size="1" name="cottontype5" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>50/50</option> <option>100%</option> </select></td> <td valign="middle" align="center" width="90"><input type="text" name="teetotal5" size="10"></td> </tr> <tr> <td width="60" valign="middle" align="center"><input type="text" name="Quantity6" size="3"></td> <td valign="middle" align="center" width="100"><select size="1" name="type6" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>Fibro Fog Tee</option> <option>Dragon Within Tee</option> </select></td> <td valign="middle" align="center" width="50"><select size="1" name="size6" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>Small</option> <option>Medium</option> <option>Large</option> <option>X-Large</option> <option>2X</option> <option>3X</option> <option>4X</option> </select></td> <td valign="middle" align="center" width="90"><select size="1" name="cottontype6" style="font-family: Arial; font-size: 8pt"> <option>Choose One</option> <option>50/50</option> <option>100%</option> </select></td> <td valign="middle" align="center" width="90"><input type="text" name="teetotal6" size="10"></td> </tr> </table> </div> <div align="right"> <table border="4" width="237"> <tr> <td style="font-family: Arial; font-size: 10pt; font-weight: bold" valign="middle" align="left" width="135"><br> Subtotal</td> <td width="80"><input type="text" name="subtotal" size="10"></td> </tr> <tr> <td style="font-family: Arial; font-size: 10pt; font-weight: bold" valign="middle" align="left" width="135"><br> Shipping&Handling</td> <td width="80"><input type="text" name="shippinghandling" size="10"></td> </tr> <tr> <td style="font-family: Arial; font-size: 10pt; font-weight: bold" valign="middle" align="left" width="135"><br> IN Residents - add 5%</td> <td width="80"><input type="text" name="indianatax" size="10"></td> </tr> <tr> <td style="font-family: Arial; font-size: 10pt; font-weight: bold" valign="middle" align="left" width="135">Insurance - optional (.50 per tee)</td> <td width="80"><input type="text" name="insurance" size="10"></td> </tr> <tr> <td style="font-family: Arial; font-size: 10pt; font-weight: bold" valign="middle" align="left" width="135"><b><font face="Arial" size="3"><br> BALANCE DUE</font></b></td> <td width="80"><input type="text" name="balancedue" size="10"></td> </tr> </table> </div> <p align="center"><input type="submit" value="Submit" name="B1"><input type="reset" value="Reset" name="B2"></p> </form> </form> </td> </tr> </table> </div> </form> <p align="left"><b><font face="Arial" size="3">Donations from our sales are made to: <br> The American Fibromyalgia Syndrome Association (AFSA)</font></b></p> <p><b><font face="Arial" size="3"><a href="#Top of Page">Back to Top</a></font></b></p> <hr> <p class="MsoTitle" align="left"><font face="Fleetwood" color="#800000"><b>©2001 NationaliTees Co., Inc.</b></font></p> <p class="MsoTitle" align="left"><font face="Fleetwood" color="#800000"><b>This page was last updated on:    10/25/07 </b></font></p> </td> </tr> </table> </div> </body>