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 or Black, Yellow, and White	Circle Size: S M L XL 2XL Medium not available in Green, Blue, and Black	$75.00 Sales Tax Included
Breathless Agony Short Sleeve T-Shirt	Red, Yellow, White and Gray logos on a Black 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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