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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