www.customguards.com
| REORDER FORM
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Please be sure to KEEP YOUR MODEL SAFE. ALL REORDERS 50% OFF WITH MODEL.
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| Sport: |
______________________________ |
| Name Of Athlete: |
______________________________ Age: ____________ |
| Home Address: |
______________________________ |
| City, State & Zip: |
______________________________ |
| Phone Number: |
________________ Date of Last Order: _____________ |
| How many guards are you ordering today: |
______________________________ |
GLADIATOR ORDER INFORMATION
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| Gladiator Style Selection: | ________________ | Gladiator Color Selection: | ________________ |
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Raptor (designed for "chewers") Available on Pro ONLY PLUS $6.00: please circle RAPTOR
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CUSTOMIZATION INFORMATION**
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| Identification on the side of your guard? _________________________ (MAXIMUM 7 characters) |
Is an image/logo/letters being used in the front of the guard? (circle one) Yes No
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| If you want a logo to be put on your mouthguard please include one of the following with this order form: A CD with the logo saved as a TIF, JPG, or a Microsoft Word file. Optionally, you can provide Sport Guard International with a web site address below where we can obtain the logo: |
| Web Address: |
http://www.______________________________
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| (If supplying SGI with a web site, a copy of the image must also be include with your model.) |
**When ordering multiple guards please complete ALL order & customization information on separate forms. |
PRICING INFORMATION
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Prices in red reflect the re-order cost for orders that will be placed with a model previously made by SGI.
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Gladiator Junior
Solid: $35.00 [$17.50]**
Bi-Color: $40.00 [$20.00]**
Tri-Color: $42.00 [$21.00]**
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Gladiator Pro
Solid: $50.00 [$25.00]**
Bi-Color: $55.00 [$27.50]**
Tri-Color: $57.00 [$28.50]**
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Gladiator Elite
Solid: $75.00 [$37.50]**
Bi-Color: $80.00 [$40.00]**
Tri-Color: $82.00 [$41.00]**
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| **Please be sure to add $ 6.00 shipping and handling to your order |
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PAYMENT INFORMATION
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Customers who select to pay with a Visa, Discover, or Mastercard, please complete the following section.
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| Name On Credit Card: |
__________________________ 3 Digit Security #: __________ |
| Credit Card #: |
__________________________ Expiration Date: ____________ |
| Credit Card's Billing Address: |
______________________________ |
| Sub total for guard(s) |
__________________________ PLUS $6.00 Total $ _________ |
Safely wrap model for mailing, SGI is not responsible for models damaged in shipping.
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Sport Guard International 3451 West Allegheny Avenue Philadelphia, PA 19132
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