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SECURE FORM

Aloha Holidays, 444 Hobron Lane Suite 215, Honolulu, HI 96815
Telephone: 808-943-0999 Fax: 808-942-4573
Email: sales@alohaholidayshawaii.com

(If you prefer, you can print the Order Form and fax it to the number above)
Fields with (*) are mandatory. A confirmation will follow.
 

*Name:  *Address:  
*City: 
*State/ Province: 

*Day Phone:     Evening #:   
   Fax:              Cell Phone:    
*Email: 
Country:  *Zip/Post: 
Enter the shirt pattern # preferred for each size and # of shirts for each size. Total the prices for payment.
    Sizes
Cost per shirt		 Sub-Total per size
   small:     $22
  medium: $23
  large:     $24
  x-large:  $25
 

Total Amount: (*)

Calculate your choices and enter the total in the box provided.
 


Enter name of your Group, if applicable:

Comments:


 
 

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Note: Blue fields with a star (*) are required

Enter the name and mailing address on your credit card below:

Cardholder Name: (*)

Address: (*)

City: (*)

 State/Province: (*)

Country: (*)

Zip/Postal: (*)

Type of Credit Card: (*)

   Num.: (*)  Expires: (*) mm/yy
 

Press the Submit button only once to prevent overcharging.

    

 (Aloha Holidays Ltd. does not share customer information with anyone, anytime, for any reason whatsoever.)