Order Form

2006 Cooper River Bridge Run Commemorative Gift

Order Form

Print This Form to Fax or Mail in Your Order

Ship To Information: [please print neatly]

Name:____________________________________________

Address: __________________________________________

_________________________________________________

City, State, Zip: _____________________________________

Country: ___________________________________________

Phone: ___________________________________________

e-mail: ___________________________________________

__________________________________________________

Name to Print on Back of Replica:

__________________________________________________

Official Finish Time:

___________________________________________________

Payment Information: Each Replica is $19.95 plus $4.25 shipping in the US. International Orders add $10.00 for shipping. SC residents add 6.5% Sales Tax per piece.

Enclosed is a check for $________________________.

Please Bill My Credit Card: (AMEX, VISA, MC, DISCOVER)

Card Number: ________________________________________

Exp. Date: ________ Billing Zip Code:_______

Name on Card: _______________________________________

Mail or Fax your Order Form to:

Fax: 843-556-0040

Mail: Custom Wood Gifts

P. O. Box 60938

North Charleston, SC 29419-0938 USA

All orders will receive an e-mail confirmation of receipt.