ASI # 300302 PPAI #374021 UPIC: PRINTPS 1-877-774-6809 www.PrintProf.net Fax: 718-325-6962 School Order Form Student’s Full Name _________________________________________________ School Name and Address _____________________________________________ __________________________________________________________________ Street Address City Zip Code School Telephone # __________________________ Fax : ___________________ School Contact Person’s Email Address __________________________________ =============================================================== Parent’s Name ______________________________________________________ __________________________________________________________________ Street Address City Zip Code Home Phone # ___________________________ Cell Pone # _________________ Email Address ______________________________________________________ Best Time to Call ____________________________________________________ ================================================================= Specific Order Information Please Check where applicable: X-Large Add $1.00 Unit Prices Sweat Shirt: Quantity ____ Size ___________ Amount $ ______.00 $14.00 Sweat Pant: Quantity ____ Size ___________ Amount $ ______.00 $14.00 T-Shirt: Quantity _____ Size ___________ Amount $ ______.00 $08.00 Total Due $ _______.00 Select Your Payment Method: Check ______ Cash ______ Credit Card ______ Card # ___________________________________________________________ Your Name as it appears on the card _____________________________________ Complete address where you receive your bill for this credit card if different from your address above. ______________________________________________________________________________ Expiration Date: Month _____Year _____3 Digit Security Code on the back of your card ______ We Accept Visa, Master Card, American Express, Discover, Visa Debit Cards and other credit cards. Our Privacy Policy: We maintain complete privacy of your credit card information. We will neither share your credit card information with any other entity nor use it for any other purposes than this order. We destroy this form one week after the delivery of your order. We keep your name, phone number, mailing address and email address in our customer database and may use them to inform you of our special offers. Make check payable to: GreenPath Group, LLC. and mail it to 2749 Yates Avenue, Bronx, NY 10469. Fax form to 718-325-6962