Beth-El Wear Order Form
Name:
Date:
Email:
Phone:
Item
Clinical Polo (Women’s) XS-XL
Cost
$30.00
Clinical Polo (Women’s) 2XL-3XL
$32.00
Clinical Polo (Men’s) XS-XL
$30.00
Clinical Polo (Men’s) 2XL-3XL
$32.00
T-Shirt (S-XL) Neon Pink, Yellow, Blue
$15.00
T-Shirt (2XL)
$5.00
Hoodie (S-XL) Black, Gray
$30.00
Hoodie (2XL-3XL) Black, Gray
$32.00
License Plate Bracket
Water Bottle
Fun T-Shirts:
‘IV Roll’
‘RN’
‘Student’
$5.00
$9.00
Size
Color
N/A
N/A
Qty
Total
N/A
N/A
N/A
N/A
N/A
Blue/Red
Style:
$16.00
$15.00
$8.00
*Size and color subjective to availability. You will be contacted if not available.
**Hoodie sales are by pre-order only, held about twice a semester. Please contact BSNA representative prior to
ordering!
***Pre-ordering a clinical polo, please contact the BSNA rep well in advance of the date needed to allow time
for your order to process if there are not any in stock.
Subtotal:
$
7.4% sales tax.
$
Final total with tax= Subtotal x 1.074.
Example: Subtotal=$30.00 x 1.074=$32.22
Final Total:
$
Please place an order form and payment in an envelope and place in the black BSNA mailbox outside the BSNA office.
The office is located around the corner from UH109. Then email Lexie Lichvar at alichvar@uccs.edu. You will be
contacted when your order is ready as to how and when to pick up your order. Refunds or exchanges will be available for
unavailable items. Please make checks payable to BSNA. We cannot accept credit cards at this time. If you have any
questions or concerns please contact alichvar@uccs.edu.