Address: _________________________________     City: _____________     State: _______     Zip: ___________

Phone Number: _____________________________     Email Address: ___________________________

Design Number: ___________________

Shirt Size: _________     Color: _______________

Check One:  Ship ($15.00) O      Pick Up Race Night ($11.00)  O

Total Amount Enclosed: _______________________

Mail This Order Form To:

Shady Bowl Speedway
411 Virginia Ave.
Troy, Ohio 45373