FSA Store Order Form
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NAME: DATE:
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ITEMPRICENUMBER ORDEREDSIZETOTAL
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Hat (tan with red, yellow, blue logo) $1.00 $0.00
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Hat (Blue and tan) (New this year)$3.00 $0.00
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Frisbee (white with red “Adoption, It’s About Love”)$1.00 $0.00
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Antenna Heart (red with white “Adoption, It’s About Love”) $0.50 $0.00
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License Plate Holder (silver with black “Adoption, It’s About Love”)$4.00 $0.00
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Pencil (red “Adoption, It’s About Love”)$0.25 $0.00
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Pen (red with white “Adoption, It’s About Love”)$0.50 $0.00
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Sippy Cup (Red writing & lid - Adoption, It's About Love)$2.00 $0.00
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Water Bottle (Silver) $8.00 $0.00
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Bibs (white, red trim, Adoption…it's about love $1.00 $0.00
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Aprons (red with It's About Love on bib)$8.00 $0.00
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Tote Bags (Red & cream with red imprint "Adoption It's About Love")$10.00 $0.00
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Plastic Bags with FSA Logo$0.40 $0.00
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Decals:"Families Supporting Adoption" & "Adoption, It's About Love"3.00 ea.$0.00
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Adult T-Shirt – White, Blue FSA logo
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All old adult T-Shirts - White, Blue FSA Logo$3.00 $0.00
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Long Sleeved Gray T-Shirt (All sizes) S, M, L, XL, XXl, XXXL$5.00 $0.00
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Gray Sweat Pants (Ladies - Adult - S, M, L, XL, XXL, XXXL)$15.00 $0.00
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Hoodies (Navy Blue) (M, L, XL)$20.00 $0.00
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Youth T-Shirt - White blue logo
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All old youth t-Shirts$3.00 $0.00
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New - Youth Gray T-Shirts$5.00 $0.00
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Infant T-Shirt – White,
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Onesies (12 mos; 18 mos)$2.00 $0.00
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Baby Beanie$1.00 $0.00
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Send Completed Form to: Peggy Shepherd (ShepherdPL@ldsfamilyservices.org) Total Order$0.00
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132 S. State St. Ste 300 Salt Lake City, UT 84111
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OR
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Philip & Valerie Hochheiser
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philvalfsa@readytek.net
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1363 N 1735 W
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Clinton, UT 84015
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