UME Preparatory Academy Shirts

Student's First and Last Name
(Student that will be picking up the order.)
 
FLEECE JACKETS
Fleece Jackets:   $24.00   Quantity:   Item Subtotal:  
$0.00
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Fleece Jackets - XXL - XXXL:   $26.00   Quantity:   Item Subtotal:  
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POLO SHIRTS

Polo Shirts:   $20.00   Quantity:   Item Subtotal:  
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Polo Shirt - XXL - XXXL:   $22.00   Quantity:   Item Subtotal:  
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LONG SLEEVE T-SHIRTS
Long Sleeve T-Shirts:   $12.00   Quantity:   Item Subtotal:  
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Long Sleeve T-Shirts XXL - XXXL:   $14.00   Quantity:   Item Subtotal:  
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T-SHIRTS

T-Shirt:   $9.00   Quantity:   Item Subtotal:  
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CREW SWEATSHIRTS
Crew Sweatshirt:   $16.00   Quantity:   Item Subtotal:  
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Crew Sweatshirts XXL - XXXL:   $18.00   Quantity:   Item Subtotal:  
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SWEATPANTS
Sweatpants:   $14.00   Quantity:   Item Subtotal:  
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Sweatpants XXL - XXXL:   $16.00   Quantity:   Item Subtotal:  
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Total:
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Payer's Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
Payment Information
Method of Payment:
Update name from Payer's Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number: (Type number or swipe with cursor in this empty field)
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Payer's Information
Cardholder's Name:
Billing Street:
Billing ZIP/Postal Code:
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