VENADO MACHO, INC.
P O BOX 690
FREER, TX 78357
361-394-5586 ofc. / 361-394-6584 fax
FORM ONLY NEEDED IF FAXING/MAILING
NAME: __________________________________________________ DATE:__________________________
ADD'L NAMES ____________________________________________________________________________
ADDRESS: ______________________________________________________CITY:_____________________
STATE:__________ ZIP: ______________ PHONE: _________________________________
EMAIL: ________________________________________________ JACKET SIZE(S): ____________
(Credit Card Fee - $1.50 per Entry)
CARD: ________________________________________________ CVC: _________ (3 Digits Off Back)
EXP. DATE__________________ NAME ON CARD: ______________________________________________
BILLING ADDRESS: ________________________________________________CITY:___________________
STATE:____________ ZIP:_______________ MENS______ LADIES______ YOUTH_______(UNDER 17)
PAY NOW WITH THE "PAYPAL" BUTTON OR MAIL/FAX/CALL
MAIL TO: P. O. BOX 690, FREER, TX 78357
FAX TO: 361-394-6584 PHONE: 361-394-5586
PLEASE MAKE CHECKS PAYABLE TO:
" VENADO MACHO"
Qualified 501(c)(3) Charity Organizaion
Federal ID 47-1592022.