Please print and fill out the form below and mail
with check payable to The Squire Shop at:

The Squire Shop
4548 Main Street
Buffalo, NY 14226
(716) 839-4243

Thank You!

Color No.	Background	Buffalo		T	T/S	BT or BC	S	LA or LS	B
1	Navy	Silver		____	____	____	____	____	____
2	Navy	Red		____	____	____	____	____	____
3	Navy	Gold		____	____	____	____	____	____
4	Maroon	Silver		____	____	____	____	____	____
5	Maroon	Navy		____	____	____	____	____	____
6	Green	Silver		____	____	____	____	____	____
7	Brown	Tan		____	____	____	____	____	____
8	Green	Tan		____	____	____	____	____	____
9	Black	Red		____	____	____	____	____	____
10	Red	Blue		____	____	____	____	____	____
11	Blue	Red		____	____	____	____	____	____
12	Tan	Brown		____	____	____	____	____	____
13	Grey	Silver		____	____	____	____	____	____
14	Gold	Blue		____	____	____	____	____	____
15	Green	Lime		____	____	____	____	____	____
16	Silver	Silver		____	____	____	____	____	____
17	Silver	Navy		____	____	____	____	____	____
18	Silver	Brown		____	____	____	____	____	____
19	Maroon	Pink		____	____	____	____	____	____
20	Navy	Emerald		____	____	____	____	____	____
Color No.	Background	Buffalo		T	T/S	BT or BC	S	LA or LS	B
Please indicate 1st, 2nd and 3rd choice by number: ___________________
Please provide billing information: Name: ______________________________________ Address: ______________________________________ City: ______________________________________ State: ______ Zip: ____________ Phone: (____) ______________ Email: ____________________ Credit Card Type: Visa     Mastercard     American Express Credit Card Number: ____________________________   Exp. Date: ______