Individual Registration

Please enter information in the form below to order your Palmetto Hat

First Name *

Last Name *

Address *

City *

State *

Zip *

Email *

Hat Color *

Tan

Black

Payment Information

Amount

$

Payment processing fee

$

Total amount

$

Payment method

Credit Card / Paypal

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*