Breathless Agony Products Order Form

Simply print this, fill it out, and drop it in the mail with your check made out to Santiago Cycling!!

PRINT CLEARLY - Mail to Santiago Cycling, 115 N. Prospect, Tustin, CA 92780  (714) 544-6091
     Or Fax with a VISA or Master Card number to (714) 832-1865

Ship-To Name and Address

Name:_____________________________________________________________

Address:___________________________________________________________

City:______________________________________ State:______ Zip:___________

Phone #:(____)_____________

E-Mail Address: ______________________________________________________

Bill-To Name and Address if using Credit Card

Name:_____________________________________________________________

Address:___________________________________________________________

City:______________________________________ State:______ Zip:___________

VISA / MasterCard ______/______/______/______ Expiration Date: ____/____

    3 Digit CVS Code from back of Card: ___________________________________

    Signature: ________________________________________________________

    $10 minimum purchase for credit cards

What year did you complete the 4 Pass Breathless Agony Century? _______________
Do not order a Jersey before you have successfully completed all 4 Passes of the ride.
Products other than Jerseys do no require completing the 4 Pass Breathless Agony Century.

Sizing Chart for VOLER Race Fit Jerseys	S	M	L	XL	2XL
Chest	35-37	38-40	40-42	42-44	44-46

Breathless Agony Jersey	Circle Colors: Yellow, Orange, and Black or Yellow, Clover Green, and Black or Green, Blue, and Black or Blue, White, Yellow, and Black or Red, Carbon Fiber Black, and Yellow	Circle Size: S M L XL 2XL Medium not available in Green, Blue, and Black	$70.00 Sales Tax Included
Breathless Agony Short Sleeve T-Shirt	Red, Yellow, Black and Gray logos on a White T-Shirt	Circle Size: S M L XL 2XL	$15.00 Sales Tax Included
Breathless Agony Long Sleeve T-Shirt	Red, Yellow, Black and Gray logos on a White T-Shirt	Circle Size: S M L XL 2XL	$20.00 Sales Tax Included
Breathless Agony Beverage Glass	Clear glass etched with awesome Breathless Agony Jersey design		$5.00 Sales Tax Included
Breathless Agony Socks	DeFeet White Socks with "Breathless Agony"in Red around top Cyclist graphic Yellow stripe		$8.00 Sales Tax Included
Shipping and Handling This is eliminated if you go to Santiago Cycling			$10.00
Make checks to: Santiago Cycling		Total:	$_________

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