lUTCHER Periquette JACKET

Lutcher Periquette Jacket Order Form

First name

Last name

Phone

Graduation Year

Jacket Size

Enter 1 if you lettered in the sport

Dance Emblem$3

Competition Team$3

Enter # of years lettered

Dance Service Bars$2

Competition Team Service Bars$2

Select "1" if you want this option

Sailor Collar - white Flap on back w/ purple braid$32

Select "1" if you want this option

Chenille "Periquettes" (on back of sailor collar) 4” – 2 color$42

Select "1" if you want this option

Chenille 3"-“Class Of” Patch (left sleeve)(includes application)$30

Select "1" if you want this option

Chenille “Dancing Girl” Patch (right sleeve)(includes application)$30

Select "1" if you want this option

Monogram 1" gold script$8

Select "1" if you want this option

Monogram 1/2" gold script (i.e. officer)$0

Select "1" if you want this option

Full Price of jacket$90

Select "1" if you want this option

Shipping - Jackets will be delivered to school. This covers shipment to school.$5

Monogram Name (right front chest) (Top line 1")

Monogram Name (right front chest) (bottom line 1/2")

You can also contact us at mnmservices@bellsouth.net with any questions.

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