Master Dave McNeill

Mailing Address:
P.O. Box 111
Minden, NV 89423

Phone: 775-267-2506
FAX : 775-267-5526

 GOJU-SHOREI ORDER FORM

HOME

For payment by Credit Card, Check or Money Order, use the form below. Allow 15 days for check clearance. Credit Card and Money Orders will insure immediate shipment. Fill in this form and print a copy. Mail, FAX or phone in your order with  the copy you printed.

Mail order form to GOJU-SHOREI SYSTEMS,
P. O. BOX 111, MINDEN, NV 89423
Call in your credit card order to 775-267-2506
FAX your credit card order to 775-267-5526

CONTACT INFORMATION
Name:    (Required Info)
Address: (Required Info)
City: (Required Info)
State:    (Required Info)  Zip:  (Required Info)
 Country:  
Phone: FAX:
Email:

VIDEOS & STUDENT TEXT BOOK
ACT Video @ $25.00 Number Ordered  
Video 1 (Yellow & Orange Ranks) @ $ 39.95 Number Ordered: 
Video 2 (Purple & Green Ranks) @ $ 39.95 Number Ordered: 
Video 3 (1st, 2nd, 3rd Brown Ranks) @ $ 39.95 Number Ordered: 
Video 4 (1st & 2nd Black Ranks) @ $ 39.95 Number Ordered: 
Video 5 (3rd, 4th and 5th Black Ranks) @ $ 39.95 Number Ordered: 
Complete Set of 5 Videos (Yellow thru 5th Black Ranks) @ $ 150.00 Number Ordered: 
.
Student Text Book (Detailed Requirements thru 5th Black Rank) @$  69.95 Number Ordered: 
Student Text Book and the 5 ranking videos @
$ 200.00		 Number Ordered: 
Shipping & Handling Charges for Domestic Only
S & H - $ 4.00 per video, $7.50 per set:   $
S & H - $ 7.50 per book, over 5 books $ 3.50 per $ 
S & H - $ 7.50 per cane, over 5 canes $ 4.50 per: $ 
Total of your Text Book and/or Video Set Order: $ 

CANES
Silver Cane @ $ 55 - $ 70 Number Ordered 
Gold Cane @ $100.00 Number Ordered 
Platinum Cane - Price to be Determined - Please Contact Master McNeill Number Ordered 
S & H - $7.50 per cane (Domestic Only) $ 
Total Cane Order Amount (Domestic Only) $ 

 APPAREL

Med = Medium • L = Large • XL = Extra Large

Weapons T-Shirts $20.00
Specify number of  shirts in the colors and sizes you want. 
Black Med   Black Large Black X-L
Blue Med    Blue Large Blue X-L
Sage Green Med SG Large SG X-L
White Med White Large White X-L
S&H - $3.20 for 1-2 Shirts (Domestic Only) $
S&H - $6.20 For 3-5 Shirts (Domestic Only) $ 
Total of Apparel Order: $ 
GRAND TOTAL OF ENTIRE ORDER: (Required Info) $

CREDIT CARD INFORMATION 

Visa   MasterCard
Name as it appears on credit card
Credit card number
Credit card expiration date  mm-yy

Fill in this form before you print it. Reset the form after you have printed it.

  

Mail ORDER FORM to
GOJU-SHOREI SYSTEMS, P. O. BOX 111, MINDEN, NV 89423
Call in your credit card order to 775-267-2506
 FAX your credit card order to 775-267-5526

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