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ELIJA'S AUTISM AWARNESS Gift Item Order Form

Sorry! We are sold out on our bracelets! Please check back soon for our new version!
 



Have fun with this one of a kind Car Magnet, while you spread awareness and even make roadside friends along the way! You'll be surprised how many people are actually in our Autism Community.

Cost is $5.00 plus $1.50 S&H


I would like to purchase _________(qty) BUMPER STICKER(s)

** Shipping is 1.50 PER item


Total amount enclosed $________

Send Check or Money Order Payable to:
The Elija Foundation
665 Newbridge Road Levittown NY 11756

We also take Visa/Mastercard (circle one) Acct#____________________________ Exp Date:________

Card Holders Signature: _____________________________

Billing Information:

Name (s) _______________________
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_______________________________
Address _________________________
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Phone ______________________ Email_______________________

Shipping Information if different from above

Name (s) _______________________
_______________________________
_______________________________
Address _________________________
_______________________________
Phone ______________________ Email_______________________