2013 Blackout Order Form

Support the Platte County Football Team & order yours today Wear it to the BLACKOUT GAME on October 18th Short Sleeved - $10

Long Sleeved - $15

**** ORDERS TAKEN UNTIL Wednesday, October 2nd ****

(front of shirt)

(back of shirt)

NAME:

PHONE:

***Deliver to School Office YES / NO --- School Name: _________________________*** SIZE/QUANTITY:

S/sleeve - $10

L/sleeve-$15

Youth SmallYouth MediumYouth Large-

Questions? Send an e-mail to [email protected] OR [email protected]

Adult SmallAdult MediumAdult LargeAdult XL-

***Return this form along with payment to: Pirate Quarterback Club PO Box 56 Platte City, MO 64079

OR

*Adult 2XL*Other - Specify size

*add $2 for 2XL and bigger

Coach Middleton at PCMS OR Coach Parrish at PCHS

by Wednesday, Oct 2nd***

TOTAL $ = ________ Payment due with order, make checks payable to:

Pirate Quarterback Club

Payment Information:

TOTAL $ = ________ Payment due with order, make checks payable to:

Pirate Quarterback Club

Cash

Check - Check # ________