Manchester Lodge 200th Anniversary Polo Shirt Order Form

 

Please provide the following information:

Your Name:   Street Address:   Address (cont.):   City:   State/Province:   Zip/Postal Code:   Home Phone:   E-mail:

Pricing is:  Small to XL is $30    XXL and above is $35

Enter quantity in front of desired size below:

-S    -M     -L     -XL     -XXL     -Other

Any Special Instructions: (Add Name, etc.)     Shipping Costs will apply.