Breathless Agony Jersey 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

Name:_____________________________________________________________

Address:___________________________________________________________

City:______________________________________ State:______ Zip:___________

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.

Phone #:(____)_____________

E-Mail Address: ______________________________________________________

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

			Total
Breathless Agony Jersey	Circle Colors: Red, Green, and Black or Yellow, Orange, and Black or Yellow, Clover Green, and Black or Green, Blue, and Black	Circle Size: S M L XL 2XL Medium not available in Green, Blue, and Black	$70.00 Sales Tax Included
Shipping and Handling This is eliminated if you go to Santiago Cycling			$10.00
Make checks to: Santiago Cycling		Total:	$_________

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

Signature: ______________________________

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