ScooterWare Secure Order Form

For more information contact:
HV Mixed Media
P.O. Box 510
Carmel, NY 10512
Toll Free:
866-HVR-SONG (487-7664)
Local: 845-225-6666
fax: 845-225-4729
hudsonvalley@earthlink.net

A HV Mixed Media site:

S E C U R E O R D E R F O R M

Below is a list of all of our ScooterWare products and their available sizes, colors and prices. Once you select the ScooterWare image you would like, simply choose the size, color and quantity. For most items, you do this by clicking on the drop down box and then making your selection. Then complete the billing and shipping information, add up your totals, shipping and tax (if in NY) and then press "SUBMIT".

If you prefer, you can use Printable Order Form to mail or fax us an order instead. Make checks or money orders payable to "HV Mixed Media"

* PLEASE DON'T FORGET TO ENTER A QUANTITY
IN THE FAR RIGHT COLUMN *

If you encounter any problem placing your on-line order,
please call us toll free at 1-866-HVR-SONG (487-7664).

ITEM	IMAGE	SIZE	COLORS	PRICE	QTY.
T-Shirt				$16.95
T-Shirt				$15.95
T-Shirt (Adult)				$12.95
T-Shirt (Child)				$11.95
T-Shirt (Infant)				$10.95

Sweatshirt				$23.95
Sweatshirt				$23.95
Sweatshirt (Adult)				$21.95
Sweatshirt (Child)				$17.95
Polo Shirt				$18.95
Henley Shirt (Long Sleeve)				$18.95

Apron		adjustable	white	$15.95
Baseball Hat		adjustable	white	$ 6.95
Visor		adjustable	white	$ 6.95
Grocery Tote Bag		one size	cream	$13.95
Zip Tote Bag		one size	cream	$14.95
10 oz. Mug		one size	white	$ 6.95
Mouse Pad		one size		$ 6.95
Full Moon Bay CD				$12.99
Full Moon Bay Cassette				$8.99
			Subtotal of items from above
			Shipping/Handling ($2.00 for each item ordered)
			Sales Tax (residents of NY only)
			TOTAL AMOUNT DUE

Billing Address
Name
Street Address
PO Box
City	State Zip
Daytime Phone
Evening Phone
Email Address
Shipping Address (if different from above)
Name
Street Address
PO Box
City	State Zip
Daytime Phone
Evening Phone
Email Address
Credit Card Information
Name on Credit Card
Credit Card	Visa Mastercard AMEX Discover
Credit Card #	Exp. Date (MM/YY)
CVV2 Code	This is the 3-digit code on back of Visa or MC, or 4-digit code on front of AmEx
Occasion/Deadline (if any)

ITEM

IMAGE

SIZE

COLORS

PRICE

QTY.