LOGOWEAR ORDER FORM. Date: FMFM Logo: MAFP Logo:
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1 LOGOWEAR ORDER FORM Name: Phone: Date: A portion of each sale directly benefits Family Medicine Foundation of Michigan, MAFP s philanthropic arm. Logo Options: When placing your order, please verify which logo you would like imprinted on each item. Options are shown below. Only one logo may be imprinted per item. MAFP Logo: FMFM Logo: Men s Classic Moisture Wicking Polo, 100% polyester pique knit 4.83 oz, Quantity Size, Cost/pc., Color Logo & Quantity TOTAL UV protection S ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. M ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. L ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. XL ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. 2XL ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. 3XL ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. MT ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. LT ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. XLT ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. Color Options: Navy or Royal XLT ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. Women s Classic Moisture Wicking Polo, 100% polyester pique knit 4.83 oz, UV protection Quantity Size, Cost/pc., Color Logo & Quantity TOTAL XS ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. S ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. M ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. L ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. XL ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. 2XL ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. 3XL ($32) Navy, Royal MAFP Logo - Qty. FMFM Logo - Qty. Color Options: Navy or Royal
2 Men s Straight Collar Chambray Shirt, 100% Cotton indigo-dyed chambray Color Options: Light denim/chambray S ($39) MAFP Logo - Qty. FMFM Logo - Qty. M ($39) MAFP Logo - Qty. FMFM Logo - Qty. L ($39) MAFP Logo - Qty. FMFM Logo - Qty. XL ($39) MAFP Logo - Qty. FMFM Logo - Qty. 2XL ($39) MAFP Logo - Qty. FMFM Logo - Qty. 3XL ($39) MAFP Logo - Qty. FMFM Logo - Qty. MT ($39) MAFP Logo - Qty. FMFM Logo - Qty. LT ($39) MAFP Logo - Qty. FMFM Logo - Qty. XLT ($39) MAFP Logo - Qty. FMFM Logo - Qty. XLT ($39) MAFP Logo - Qty. FMFM Logo - Qty. Women s Straight Collar Chambray Shirt, 100% Cotton indigo-dyed chambray XS ($39) MAFP Logo - Qty. FMFM Logo - Qty. S ($39) MAFP Logo - Qty. FMFM Logo - Qty. M ($39) MAFP Logo - Qty. FMFM Logo - Qty. L ($39) MAFP Logo - Qty. FMFM Logo - Qty. XL ($39) MAFP Logo - Qty. FMFM Logo - Qty. 2XL ($39) MAFP Logo - Qty. FMFM Logo - Qty. 3XL ($39) MAFP Logo - Qty. FMFM Logo - Qty. Color Options: Light denim/chambray Women s Fitness Jacket, 92% polyester/8% spandex Jersey Knit 7.3 oz XS ($59) MAFP Logo - Qty. FMFM Logo - Qty. S ($59) MAFP Logo - Qty. FMFM Logo - Qty. M ($59) MAFP Logo - Qty. FMFM Logo - Qty. L ($59) MAFP Logo - Qty. FMFM Logo - Qty. XL ($59) MAFP Logo - Qty. FMFM Logo - Qty. 2XL ($59) MAFP Logo - Qty. FMFM Logo - Qty. 3XL ($59) MAFP Logo - Qty. FMFM Logo - Qty.
3 Men s Sport Wick Stretch ½ Zip Pullover XS ($37) MAFP Logo - Qty. FMFM Logo - Qty. S ($37) MAFP Logo - Qty. FMFM Logo - Qty. M ($37) MAFP Logo - Qty. FMFM Logo - Qty. L ($37) MAFP Logo - Qty. FMFM Logo - Qty. XL ($37) MAFP Logo - Qty. FMFM Logo - Qty. 2XL ($37) MAFP Logo - Qty. FMFM Logo - Qty. 3XL ($37) MAFP Logo - Qty. FMFM Logo - Qty. 4XL ($37) MAFP Logo - Qty. FMFM Logo - Qty. Item represented in color to show detail Women s Cardigan Wrap XS ($41) MAFP Logo - Qty. FMFM Logo - Qty. S ($41) MAFP Logo - Qty. FMFM Logo - Qty. M ($41) MAFP Logo - Qty. FMFM Logo - Qty. L ($41) MAFP Logo - Qty. FMFM Logo - Qty. XL ($41) MAFP Logo - Qty. FMFM Logo - Qty. 2XL ($41) MAFP Logo - Qty. FMFM Logo - Qty. 3XL ($41) MAFP Logo - Qty. FMFM Logo - Qty. Item represented in color to show detail Women s Colorblock Mélange Fleece, Full Zip XS ($50) MAFP Logo - Qty. FMFM Logo - Qty. S ($50) MAFP Logo - Qty. FMFM Logo - Qty. M ($50) MAFP Logo - Qty. FMFM Logo - Qty. L ($50) MAFP Logo - Qty. FMFM Logo - Qty. XL ($50) MAFP Logo - Qty. FMFM Logo - Qty. 2XL ($50) MAFP Logo - Qty. FMFM Logo - Qty. 3XL ($50) MAFP Logo - Qty. FMFM Logo - Qty. Color: Black with heather gray
4 Men s Colorblock Mélange Fleece, Full Zip S ($50) MAFP Logo - Qty. FMFM Logo - Qty. M ($50) MAFP Logo - Qty. FMFM Logo - Qty. L ($50) MAFP Logo - Qty. FMFM Logo - Qty. XL ($50) MAFP Logo - Qty. FMFM Logo - Qty. 2XL ($50) MAFP Logo - Qty. FMFM Logo - Qty. 3XL ($50) MAFP Logo - Qty. FMFM Logo - Qty. 4XL ($50) MAFP Logo - Qty. FMFM Logo - Qty. Color: Black with heather gray Men s White Coat, Knee length with five button, side hand access, three front pockets, 40 ½ long Logo Options: MAFP ONLY Quantity Size & Cost/pc. TOTAL 32 ($43) 34 ($43) 36 ($43) 38 ($43) 40 ($43) 42 ($43) 44 ($43) 46 ($43) 48 ($43) 50 ($43) 52 ($43) Women s White Coat, Knee length with five button, side hand access, three front pockets, 40 ½ long Logo Options: MAFP ONLY Quantity Size & Cost/pc. TOTAL 0 ($48) 2 ($48) 4 ($48) 6 ($48) 8 ($48) 10 ($48) 12 ($48) 14 ($48) 16 ($48) 18 ($48) 20 ($48)
5 Padfolio made from simulate leather features a zipper closure, multi-function organizer, scratch resistant pocket for 10 tablet, holds 8 ½ x 11 paper Price $19 Two Tone Color block Tote, zippered main compartment and zippered outer pocket Price $20.50 Logo Options: Dual MAFP & FMFM ONLY Logo Options: Dual MAFP & FMFM ONLY First Name: Last Name: Shipping Address Street: City: State: Zip: Billing Address (If different than shipping address listed above) Street: City: State: Zip: Orders must be received no later than July 21, Submit orders and credit card information to deannad@foresightgroup.net OR fax to Or send orders to: Foresight Group, Attention Deanna Dowling, 2822 N Martin Luther King Jr. Blvd., Lansing, MI Visa and Mastercard are accepted. Card Number: Exp Date: 3 digit CVC code from back My total order is for items totaling $. Base shipping of $12 (plus $2 for each additional item) will be added to your total (i.e., shipping for an order of two items will be $14).
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