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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