"One In Spirit" Wristband
Order Form

Wristband can be ordered in packages of 10 or 100. Please specify below.

Print this form and return with payment to address listed below.
10 Wristbands per Package

Quantity (packages)

Wristband Size
(no mixed packages)

 Price Total
p Youth Wristband $20.00 per package  $
p Adult Wristband $20.00 per package  $

Shipping Charge: $2.50 per package

  $

GRAND TOTAL

  $
100 Wristbands per Package - FREE SHIPPING!

Quantity (packages)

Bracelet Size
(no mixed packages)

 Price Total
p Youth Wristband $200.00 per package  $
p Adult Wristband $200.00 per package  $

Shipping Charge: FREE

 no charge

GRAND TOTAL

  $
Pre-Packed Display Box of 25 Wristband (12 Youth, 13 Adult)

Quantity (boxes)

Price Total
p Box sets $50.00 per box  $

Shipping Charge: $5.00 per box

  $

GRAND TOTAL

  $
SHIPPING INFORMATION: PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO:
NAME:________________________________________________

ADDRESS:_____________________________________________

TOWN: _______________________________   

STATE __________    ZIP  ________

 Louis J. Acompora Memorial Foundation
P.O. Box 767
Northport, NY  11768
Please include payment with this order form.
If you have any questions, please call (631) 754-1091