Fax to:            Sir Joseph Inc    Your Company/Your Name : _______________________________________         

Fax Number :  919-554-1292        Your Fax Number/Phone Number : __________________/_________________          ===================================================================================================

                                     Extra Small        Small           Medium         Large        Extra Large                                                  

Black                                ____              ____               ____             ____            ____ 

Tan                                   ____              ____               ____             ____            ____ 

Blue                                  ____              ____               ____             ____             ____ 

Brown                               ____              ____               ____             ____             ____ 

Wine                                 ____              ____               ____             ____             ____  

Green                               ____              ____               ____             ____             ____  

Purple                              ____              ____               ____             ____             ____

Red                                  ____              ____               ____             ____             ____

Pink                                  ____              ____               ____             ____              n/a

Yellow                               n/a                ____               ____             ____              n/a 

White                                n/a                ____               ____             ____              n/a 

Adjustable Strap                 n/a                ____               ____             ____              n/a 

Black Canvas Chalkholder(one size only)                        ____ 

Retractable Chalkholder(one size only)                            ____  =======================================================================================

Address 1: ________________________________       Address 2 : _______________________________   

City: __________________________    State : ___   Postal Code : _______     Country : ______________  

Visa/Master Card : _____      Card Number : ____________________________  Expire Date : __________

Email Address : _____________________________    Comments : _________________________________________

When you submit your order via fax, you will receive an order confirmation via fax a within 24 hours. Please check your fax machine for your confirmation tomorrow at this time. Visa and Master Card only!  Thank you for your order - Sir Joseph