Order Form Address correspondence to:

To place orders by phone, please call 503‐502‐8351. FosterClubOrders may be faxed to 503‐717‐1552. 753 First Avenue

Seaside, OR 97138

Order Date:  3/2/10

BILL TO: SHIP TO:

Name: Name:

Address: Address:

City, State, Zip: City, State, Zip:

Phone: Phone:

E‐mail E‐mail

Item # DescripQon Size/Color/Special Info Cost Per QuanQty Subtotal

[42] SUBTOTAL 0.00

Payment InformaQon SHIPPING 0.00

Payment Method: OTHER 0.00

TOTAL 0.00

Credit Card #:ExpiraQon Date:Code: Notes + special instrucQonsName on card:

Signature:

P.O*Visa MasterCard American Express Check*

Item # DescripQon Size/Color/Special Info Cost Per QuanQty Subtotal

[42] SUBTOTAL 0.000 3/2/10