YSA and UnitedHealthcare are

teaming up to help fight childhood obesity!

To order shirts and beanies for your group, call Kristen Bourbeau at 1-866-446-3530 ext. 2102,
or email her at Kristen.Bourbeau@StaplesPromoProducts.com
Please place your order earlyto allow 3-4 weeks for production.
There is a 12 pc minimum order for each different item, so plan to order for your entire group at one time.

Front Logo
Vertical

Decoration
on back

2
4

Front Logo f
Decoration

Decoration
on back

Front Logo
Horizontal

1. Beanie: 100% Acrylic Knit 8 beanie. USA Made. Royal Blue. Embroidered.
2. Ladies Short Sleeve V-Neck T-shirt: 4.2 oz. pre-shrunk 100% combed ringspun cotton. True Blue.
3. Crewneck T-shirt (UHC Vertical): 6.0 oz. ComfortSoft 100% cotton, pre-shrunk t-shirt. Taped shoulder to shoulder. Royal Blue.
4. Crewneck T-shirt (UHC Horizontal): 6.0 oz. ComfortSoft 100% cotton, pre-shrunk t-shirt. Taped shoulder to shoulder. Royal Blue.

Fax to 1-419-861-2055 attn: Kristen Bourbeau. Orders must be received by Friday April 20, 2012.

YSA Beanie & T-Shirt Order Form

bill to:

ship to:

Name__________________________________________________________________

name__________________________________________________________________

attn.___________________________________________________________________

attn.___________________________________________________________________

address________________________________________________________________

address________________________________________________________________

city____________________________________st______zip___________________

city____________________________________st______zip___________________

phone ( ________ ) _____________________ fax ( ________ )_________________

phone ( ________ ) _____________________ fax ( ________ )___________________

e-mail__________________________________________________________________

e-mail__________________________________________________________________

_____ commercial ____ residential

thisaddressis:

Description

Item #

Beanie

Ladies S/S Vneck Tshirt

S-XL

Color

Qty.

Price

Royal
Blue

12-23
24-47
48-71
72-143
144+
12-23
24-47
48-71
72-143
144+
12-23
24-47
48-71
72-143
144+
12-23
24-47
48-71
72-143
144+
12-23
24-47
48-71
72-143
144+
12-23
24-47
48-71
72-143
144+
12-23
24-47
48-71
72-143
144+

$5.96
5.55
5.06
5.06
4.80
17.76
12.18
10.63
9.56
9.03
19.58
13.99
12.44
11.37
10.85
14.04
8.45
6.90
5.84
5.31
15.65
10.06
8.51
7.44
6.92
14.04
8.45
6.90
5.84
5.31
15.65
10.06
8.51
7.44
6.92

True Blue

2XL

Vertical Crewneck
Tshirt
S-XL

Royal
Blue

2XL-6XL

Horizontal Crewneck
Tshirt
S-XL

Royal
Blue

2XL-6XL

Description

Ordering Information:
Your purchases are backed by our 90-day Satisfaction Guarantee. If the
merchandise you order does not meet your expectations, we will gladly
exchange it or accept the return for a refund or credit within 90 days of
when you receive your order. Return information is printed on the back of
the packing slip that accompanies your order.
All purchases are payable in US dollars.
Please place your order earlyto allow 3-4 weeks for production.
There is a 12 pc minimum order for each different item, so plan to
order for your entire group at one time.

Method
Of payment Sorry, No C.O.D. Orders

MasterCard

Visa

American Express

Bill my Account

Account No.
Expiration Date
MONTH

YEAR

Cardholder Name (please print): _____________________________________________

Cardholder Billing Address: _________________________________________________
Please print your CVC (Credit Verification Code) here: _______ _______ _______
This three digit code can be found on the back of the card in the signature field after the credit card number.

Indicate Quantity
S

Discover

XL

2XL

3XL

Fax to 1-419-861-2055 attn: Kristen Bourbeau.

Orders must be received by Friday April 20, 2012.

4XL

5XL

6XL

Total
Qty.

Price
Each

Total
Amount

SUB TOTAL

Add State/Local Sales Tax. If Tax Exempt,

Please Attach Copy of Exemption Certificate

ORDER TOTAL

Thank you!
71238 2/2012