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Purple Panther Order Form
Print this form out and mail or FAX it to us
Thanks for Your Order
7560 W. Sunset Blvd. Hollywood, CA 90046
Tel: (323) 882 8165 Fax: (323) 882 6701


Name _____________________________  
Address ____________________________  
City _______________________________ 
State _________ Zip _________________
Email Address _________________________
 Phone ______________________________
Bumper Sticker
$2.00
  (includes shipping and handling)
Quantity ______

CREDIT CARD ORDERS  VISA/MC/AMEX/DISCOVER 
Card No. __________________
Exp. Date ________

Signature _______________________________

the Back Machine
$500.00

(domestic Orders add $60 s/h,
International Orders please call
for shipping charges)

Tattoo Chops T-Shirt
(black shirt w/ white print)
Size (circle one)    M  L  XL  XXL

Quantity ______

Girl Riding Panther T-Shirt
(black shirt w/ purple design)
Size (circle one)    M  L  XL  XXL

Quantity ______

Panther Queen T-Shirt
(black shirt w/ full color design)
Size (circle one)   M  L  XL  XXL

Quantity ______

Panther Girl T-Shirt
(black shirt w/ purple design)
Size (circle one)  M  L  XL  XXL

Quantity ______

Business Card Logo T-Shirt
(black shirt w/ purple design)
Size (circle one)    M  L  XL  XXL

Quantity ______

Winged Panther T-Shirt
(white shirt)
Size (circle one)    M  L  XL  XXL

Quantity _____

Hold Fast T-Shirt
(black shirt)
Size (circle one)    M  L  XL  XXL

Quantity ______

Winking Panther T-Shirt
(black shirt)
Size (circle one)    M  L  XL  XXL

Quantity _____

All Shirts $20.00 plus s/h
Graham Chaffee Set #1    Set of 8
$100.00
Quantity ______		 Graham Chaffee Set #2    Set of 8
$100.00
Quantity ______
John Rhodes Set #1    Set of 10
$125.00
Quantity ______ 		Maxine Miller Set #1    Set of 10
$125.00
Quantity ______
Ron Cordy Set #1    Set of 10  
 $125.00
Quantity ______		  
Active Ingredients
$100
Quantity_______
Hollywood Housewives
$100
Quantity_______
   
Item (by category) Quantity Price
Flash    
T-Shirts    
Stickers    
Art Prints    
(other)    
(other)    
Subtotal    
+ s/h    
Total    
Shipping & Handling Charges:
domestic orders
Flash (up to 3 sets)   $7.00
T-Shirts (up to 3 shirts)   $7.00
Art Prints (up to 2 prints)   $7.00
International orders
Flash   $20.00
T- Shirts   $20.00
Art Prints   $20.00
In order to help ensure safe delivery ofpaper
items, Flash, T-Shirts, and Art prints are shipped
as separate orders. Please include appropriate
shipping for each order.

Mail Your Order To:

7560 W. Sunset Blvd.
Hollywood, CA 90046 
Purple Panther Tattoo

 Tel: (323) 882 8165
Fax: (323) 882 6701
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