BILLING INFORMATION IF PAYING
BY: 
Please Print & Fill Out Form and Return with Check / Money Order to the Following Address:
BRADY SMITH
9065 East Lake Avenue
Solon Springs, WI 54873
| SHIPPING INFORMATION: (Required) |
| NAME:(Please Print)______________________________________________________________ |
| ADDRESS:______________________________________________________________________ |
| CITY:________________________________________STATE_________ZIP:_______________ |
| DAYTIME PHONE:________________________EVENING PHONE______________________ |
| EMAIL ADDRESS:_______________________________________________________________ |
BILLING INFORMATION IF PAYING
BY: |
| NAME ON CARD:(Please Print)______________________________________________________________ |
| ADDRESS:______________________________________________________________________ |
| CITY:________________________________________STATE_________ZIP:_______________ |
| DAYTIME PHONE:________________________EVENING PHONE______________________ |
| CREDIT CARD NUMBER:________________________________________________________ |
| EXPIRATION DATE:_____________________CVC CODE:_____________________________ |
| DESCRIPTION | PRICE | BLACK QTY | WHITE QTY | TOTAL |
| Black & White "Grim Reaper" T-Shirts | ||||
Size Kids Medium |
$25.00 | __________ | __________ | __________ |
Size Kids Large |
$25.00 | __________ | __________ | __________ |
Size Adult Small |
$25.00 | __________ | __________ | __________ |
Size Adult Medium |
$25.00 | __________ | __________ | __________ |
Size Adult Large |
$25.00 | __________ | __________ | __________ |
Size Adult XL |
$25.00 | __________ | __________ | __________ |
Size Adult 2XL |
$27.00 | __________ | __________ | __________ |
Size Adult 3XL |
$28.00 | __________ | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| Black "Grim Reaper" Hooded Sweatshirts | |||
Size Kids Medium |
$40.00 | __________ | __________ |
Size Kids Large |
$40.00 | __________ | __________ |
Size Adult Small |
$40.00 | __________ | __________ |
Size Adult Medium |
$40.00 | __________ | __________ |
Size Adult Large |
$40.00 | __________ | __________ |
Size Adult XL |
$40.00 | SOLD OUT!!! | __________ |
Size Adult 2XL |
$42.00 | __________ | __________ |
Size Adult 3XL |
$43.00 | __________ | __________ |
Size Adult 4XL |
$44.00 | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| Black "Double Skull" Hockey Hooded Sweatshirts | |||
Size Adult Small |
$45.00 | SOLD OUT!!! | __________ |
Size Adult Medium |
$45.00 | __________ | __________ |
Size Adult Large |
$45.00 | SOLD OUT!!! | __________ |
Size Adult XL |
$45.00 | __________ | __________ |
Size Adult 2XL |
$45.00 | __________ | __________ |
Size Adult 3XL |
$45.00 | SOLD OUT!!! | __________ |
| DESCRIPTION | PRICE | YELLOW QTY | ORANGE QTY | TOTAL |
| Yellow & Orange "Jekyll & Hyde" T-Shirts | ||||
Size Kids XSmall |
$20.00 | __________ | __________ | __________ |
Size Kids Small |
$20.00 | __________ | __________ | __________ |
Size Kids Medium |
$25.00 | __________ | __________ | __________ |
Size Kids Large |
$25.00 | __________ | __________ | __________ |
Size Adult Small |
$25.00 | __________ | __________ | __________ |
Size Adult Medium |
$25.00 | __________ | __________ | __________ |
Size Adult Large |
$25.00 | __________ | __________ | __________ |
Size Adult XL |
$25.00 | __________ | __________ | __________ |
Size Adult 2XL |
$27.00 | __________ | __________ | __________ |
Size Adult 3XL |
$28.00 | __________ | SOLD OUT!!! | __________ |
Size Adult 4XL |
$29.00 | SOLD OUT!!! | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| Orange "Jekyll & Hyde" Hooded Sweatshirts | |||
Size Kids XSmall |
$40.00 | __________ | __________ |
Size Kids Small |
$40.00 | __________ | __________ |
Size Kids Medium |
$40.00 | __________ | __________ |
Size Kids Large |
$40.00 | __________ | __________ |
Size Adult Small |
$40.00 | __________ | __________ |
Size Adult Medium |
$40.00 | __________ | __________ |
Size Adult Large |
$40.00 | SOLD OUT!!! | __________ |
Size Adult XL |
$40.00 | __________ | __________ |
Size Adult 2XL |
$42.00 | __________ | __________ |
Size Adult 3XL |
$43.00 | SOLD OUT!!! | __________ |
Size Adult 4XL |
$44.00 | SOLD OUT!!! | __________ |
| DESCRIPTION | PRICE | BLACK QTY | WHITE QTY | TOTAL |
| Black & White "Get Your Horns Up" T-Shirts | ||||
Size Adult Small |
$25.00 | __________ | __________ | __________ |
Size Adult Medium |
$25.00 | SOLD OUT!!! | SOLD OUT!!! | __________ |
Size Adult Large |
$25.00 | __________ | SOLD OUT!!! | __________ |
Size Adult XL |
$25.00 | __________ | __________ | __________ |
Size Adult 2XL |
$27.00 | SOLD OUT!!! | __________ | __________ |
Size Adult 3XL |
$28.00 | __________ | __________ | __________ |
Size Adult 4XL |
$29.00 | __________ | __________ | __________ |
| DESCRIPTION | PRICE | PINK QTY | BLACK QTY | GRAY QTY | TOTAL |
| Pink, Black, & Gray Women's Fitted Tees | |||||
Size Adult Small |
$25.00 | SOLD OUT!!! | __________ | __________ | __________ |
Size Adult Medium |
$25.00 | SOLD OUT!!! | __________ | __________ | __________ |
Size Adult Large |
$25.00 | __________ | __________ | SOLD OUT!!! | __________ |
Size Adult XL |
$25.00 | SOLD OUT!!! | __________ | SOLD OUT!!! | __________ |
Size Adult 2XL |
$25.00 | SOLD OUT!!! | __________ | SOLD OUT!!! | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| Black "Reaper" T-Shirts | |||
Size Adult Small |
$25.00 | __________ | __________ |
Size Adult Medium |
$25.00 | __________ | __________ |
Size Adult Large |
$25.00 | __________ | __________ |
Size Adult XL |
$25.00 | __________ | __________ |
Size Adult 2XL |
$25.00 | SOLD OUT!!! | __________ |
Size Adult 3XL |
$25.00 | __________ | __________ |
| DESCRIPTION | PRICE | BLACK QTY | WHITE QTY | TOTAL |
| Black & White Scott Bloomquist Racing T-Shirts | ||||
Size Adult Small |
$30.00 | __________ | __________ | __________ |
Size Adult Medium |
$30.00 | SOLD OUT!!! | __________ | __________ |
Size Adult Large |
$30.00 | __________ | __________ | __________ |
Size Adult XL |
$30.00 | __________ | __________ | __________ |
Size Adult 2XL |
$30.00 | SOLD OUT!!! | SOLD OUT!!! | __________ |
Size Adult 3XL |
$30.00 | SOLD OUT!!! | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| Black "Team Zero" T-Shirts | |||
Size Adult Small |
$30.00 | __________ | __________ |
Size Adult Medium |
$30.00 | __________ | __________ |
Size Adult Large |
$30.00 | __________ | __________ |
Size Adult XL |
$30.00 | __________ | __________ |
Size Adult 2XL |
$30.00 | SOLD OUT!!! | __________ |
Size Adult 3XL |
$30.00 | __________ | __________ |
| DESCRIPTION | PRICE | GRAY QTY | BURGANDY QTY | TOTAL |
| Charcoal Gray & Burgandy "Tour Dates" T-Shirts | ||||
Size Adult Small |
$25.00 | __________ | __________ | __________ |
Size Adult Medium |
$25.00 | __________ | __________ | __________ |
Size Adult Large |
$25.00 | __________ | __________ | __________ |
Size Adult XL |
$25.00 | __________ | __________ | __________ |
Size Adult 2XL |
$27.00 | __________ | __________ | __________ |
Size Adult 3XL |
$28.00 | SOLD OUT!!! | __________ | __________ |
| DESCRIPTION | PRICE | WHITE QTY | BLACK QTY | TOTAL |
| White & Black "Prodigy Slash" T-Shirts | ||||
Size Kids 2/4 |
$20.00 | __________ | SOLD OUT!!! | __________ |
Size Kids 6/8 |
$20.00 | __________ | __________ | __________ |
Size Kids 10/12 |
$25.00 | __________ | __________ | __________ |
Size Kids 14/16 |
$25.00 | __________ | SOLD OUT!!! | __________ |
Size Adult Small |
$25.00 | SOLD OUT!!! | SOLD OUT!!! | __________ |
Size Adult Medium |
$25.00 | SOLD OUT!!! | SOLD OUT!!! | __________ |
Size Adult Large |
$25.00 | __________ | SOLD OUT!!! | __________ |
Size Adult XL |
$25.00 | __________ | SOLD OUT!!! | __________ |
Size Adult 2XL |
$27.00 | SOLD OUT!!! | SOLD OUT!!! | __________ |
Size Adult 3XL |
$28.00 | __________ | SOLD OUT!!! | __________ |
Size Adult 4XL |
$29.00 | SOLD OUT!!! | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| Black "Prodigy Slash" Hoodies | |||
Size Kids 2/4 |
$40.00 | __________ | __________ |
Size Kids 6/8 |
$40.00 | __________ | __________ |
Size Kids 10/12 |
$40.00 | __________ | __________ |
Size Kids 14/16 |
$40.00 | __________ | __________ |
Size Adult Small |
$40.00 | __________ | __________ |
Size Adult Medium |
$40.00 | __________ | __________ |
Size Adult Large |
$40.00 | __________ | __________ |
Size Adult XL |
$40.00 | __________ | __________ |
Size Adult 2XL |
$42.00 | __________ | __________ |
Size Adult 3XL |
$43.00 | __________ | __________ |
Size Adult 4XL |
$44.00 | __________ | __________ |
| DESCRIPTION | PRICE | GRAY QTY | ORANGE QTY | TOTAL |
| Charcoal Gray & Orange "Double Skull" T-Shirts | ||||
Size Adult Small |
$25.00 | SOLD OUT!!! | __________ | __________ |
Size Adult Medium |
$25.00 | __________ | SOLD OUT!!! | __________ |
Size Adult Large |
$25.00 | __________ | __________ | __________ |
Size Adult XL |
$25.00 | __________ | SOLD OUT!!! | __________ |
Size Adult 2XL |
$25.00 | __________ | SOLD OUT!!! | __________ |
Size Adult 3XL |
$25.00 | __________ | SOLD OUT!!! | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| Brady Smith Hats | |||
Black/Orange Skull Centered
Hat |
$25.00 | __________ | __________ |
Black/Orange Skull Offset
Hat |
$25.00 | __________ | __________ |
Skull Fitted Mesh Hat
(Size S/M) |
$25.00 | __________ | __________ |
Skull Fitted Mesh Hat
(Size L/XL) |
$25.00 | __________ | __________ |
Gray Torn #2 Hat |
$25.00 | __________ | __________ |
Black / Blue #2 Hat |
$10.00 | __________ | __________ |
Multi-Colored Brady
Smith Hat |
$10.00 | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| Brady Smith Stickers | |||
Sticker #1 |
$5.00 | __________ | __________ |
Sticker #2 |
$5.00 | __________ | __________ |
Sticker #3 |
$5.00 | __________ | __________ |
Sticker #4 |
$5.00 | __________ | __________ |
Sticker #5 |
$5.00 | __________ | __________ |
Sticker #6 |
$5.00 | __________ | __________ |
Sticker #7 |
$5.00 | __________ | __________ |
Sticker #8 (Small) |
$5.00 | __________ | __________ |
Sticker #8 (Large) |
$7.00 | __________ | __________ |
Sticker #9 |
$5.00 | __________ | __________ |
Sticker #10 |
$5.00 | __________ | __________ |
Sticker #11 |
$5.00 | __________ | __________ |
Sticker #13 |
$5.00 | __________ | __________ |
Sticker #14 |
$5.00 | __________ | __________ |
| DESCRIPTION | PRICE | QUANTITY | TOTAL |
| Misc. Brady Smith Items | |||
Used #2 Door Panel |
$100.00 | __________ | __________ |
Used #2 Quarter Panel |
$50.00 | __________ | __________ |
Brady Smith 1:64 Scale Diecast |
$15.00 | __________ | __________ |
#2 Black Mini-Door |
$35.00 | __________ | __________ |
#2 Orange Mini-Door |
$35.00 | __________ | __________ |
Brady Smith Dog Tag |
$5.00 | __________ | __________ |
Brady Smith Mugs |
$5.00 | __________ | __________ |
Brady Smith Can Coolies |
$5.00 | __________ | __________ |
| Please Add $8.00 S&H to your Amount Totals | $8.00 |
| Please Add all Total Amounts + Shipping & Handling | __________ |