Cooperative Fitness Challenge
Award Pin Purchase Form

Make Checks Payable to S&S Worldwide


Ship to (your name): ____________________________________ Date: ___________

School/Organization Name: _______________________________________________

Street: _______________________________________________________________

City: _______________________________ State: ___________ Zip: _____________

Phone: ________________ Fax: ________________ E-mail: ____________________

ITEM

QUANTITY

ITEM COST

TOTAL

Gold  
X $1.19
 =
Silver  
X $1.19
 =
Bronze  
X $1.19
 =
   

Subtotal:

 =
   

Shipping Cost
$8.95 on orders 0-$60
15% on orders $60.01-$749.99
10% on orders $750+

 =
    CT, NJ, NY Residents add applicable sales tax  =
   

TOTAL:

 =

Make Checks and Purchase Orders payable to: S&S Worldwide
(Mail to: S&S Worldwide, 75 Mill Street, Colchester, CT 06415; Fax: 866-776-9170)