WCBD Accessories Order Form
Please complete the information below carefully to ensure you receive your purchase.

The White Coats Black Doctors Founders' Logo represents solidarity, support and excellence in medicine. Now available on a 1" lapel pin or 1.5" clip-on badge reel, medical students, physicians and supporters can choose to show their pride any way they please. Ca$hApp & PayPal (most major credit cards) accepted.

If you would like to order more items than this form allows, please submit an additional order form or contact orders@whitecoatsblackdoctors.org for assistance.
Full Name *
Your answer
Email Address *
Your answer
Phone Number *
Please enter your mobile phone number in the following format: 123-555-7890. Note: We may contact you via SMS regarding your order.
Your answer
Shipping Address *
Please enter street address, city, state & ZIP. Press the enter key on your keyboard for a new line.
Your answer
Number of Silver Pins *
$15 each.
Captionless Image
Number of Gold Pins *
$15 each.
Captionless Image
Number of Hats *
6-Panel unconstructed brushed cotton "dad-style" cap with adjustable brass snap buckle closure. $20 each.
Captionless Image
Number of Badge Reels *
Now available in black, with secure grip alligator clip. $5 each.
Captionless Image
Number of Phone Grips - NEW! *
WCBD Custom LoveHandle Phone Grip, perfect for selfies, gifts, or juggling that latté on the wards! $7 each.
Captionless Image
NEW Add-On Item! Removable WCBD Decal *
White vinyl sticker to be proudly displayed on your water bottle, laptop, or car. Microwave & dishwasher safe, with no sticky residue!
Captionless Image
Shipping Preference (USPS-- 3-5 business days) *
Order total, in USD *
$15 per pin, $5 per badge reel, $7 per phone grip & $1.50 per sticker. Don't worry, one of our interns will check your math!
Your answer
Payment Method (Select CashApp or PayPal) *
Click or scan the link of your desired payment method to enter your payment in a new window, then RETURN to this form to complete your order. (No need to wait for a request or charge from us!)
Failure to submit payment with your order may result in your order being delayed, marked incomplete, or canceled.

Because we are student-led, orders may take up to 7 days to process.
Additional Order Comments
Got a question that can't wait? Having trouble? Email orders@whitecoatsblackdoctors.org or text us at 302-564-9223.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service