EmailMeForm
VA Heartbeat Shirt Order Form
Please verify your information before submitting this form. Most fields on this form are required. Select NA or 0 for those areas not applicable.
Questions regarding placing your order, please call Dianne at 504-430-3389 or via email at dianne@deejaestitch4me.com.
You can pay via Venmo, CashApp, Cash, Zelle, or PayPal.
Venmo: @Dianne-Ricks
CashApp: $DeeWayRicks
PayPal: @DianneWay or dwayricks@yahoo.com
Zelle: 504-430-3389
Please verify your information BEFORE submitting your order. Any requested changes required after you hit submit, will require you to submit ANOTHER order form with the correct information.
Name
*
First
Last
Floor/Unit
*
Email
*
Cell Phone/Work Phone #
*
###
-
###
-
####
DriFit Shirt Color; Please Note: The checkbox to select your shirt color appears before the color.
*
Black
Pink
Royal Blue
Original Purple
White
Red
Navy Blue
New Purple Shirt(Runs Small)
NA
This is a multiple choice field. You are able to select multiple shirt colors.
Shirt Size; The checkbox to select the size appears befor the size required.
*
XS ($32.00)
Small ($32.00)
Medium ($32.00)
Large ($32.00)
XL ($32.00)
2XL ($34.00)
3XL ($34.00)
4XL ($37.00)
NA
All DriFit Shirts RUN LARGE with the EXCEPTION of the "New Purple Shirts", they run SMALL so please make sure you select the correct size. XS only available for Pink Shirts.
PLEASE VERIFY YOUR SHIRT SIZE BEFORE SUBMITTING ORDER FORM. PLEASE NOTE: THE NEW PURPLE SHIRTS RUN SMALL.
# DriFit Shirts Ordered
*
DriFit Shirt Total:
*
Calculate the number of drifit shirts ordered by the cost and place that value in this field
Name on DriFit Shirt
*
Please double check this information for accuracy before submitting the form.
Comments/Notes:
Cotton Shirt Color: The Check box to select your shirt color appears before the color. (Skip this entire section if you are not ordering a cotton shirt)
Black
Pink
Royal Blue
White
Red
Purple
This is a multiple choice field. You are able to select multiple shirt colors.
Cotton Shirt Size; The checkbox to select the size appears before the size required.
Small ($20.00)
Medium ($20.00)
Large ($20.00)
XL ($20.00)
2XL ($22.00)
3XL ($22.00)
4XL ($25.00)
# Cotton Shirts Ordered
Cotton Shirt Total:
Calculate the number of cotton shirts ordered by the cost and place that value in this field
Name on Shirt
Please double check this information for accuracy before submitting the form.
Total # of Shirts Ordered (DriFit+Cotton if applicable)
*
Add up the number of DriFit + Cotton shirts ordered and place that value in this field.
Total Amount Due: (Total For DriFit + Cotton Shirt if applicable)
*
Add up the DriFit Shirt Total + the Cotton Shirt total and place that amount in this field.
Please indicate your Payment Method
*
Venmo
CashApp
PayPal
Zelle
