Champion Diamonds - Printable Order Form

Champion Athletics
Internet Sales

Name:

Address:

City: State: Zip:

Daytime Phone:

Evening Phone:

E-Mail Address:

Fax to: 417-667-4937

Mail to: Champion Athletics
300 W. Cherry
Nevada, MO 64772

417-667-4993 for Phone Orders!

Your Order

*Item #*	*Description*	*Color*	*Size*	*Hand*	*Qty*	*Price*	*Total*
				R L		$	$
				R L		$	$
				R L		$	$
				R L		$	$
				R L		$	$
				R L		$	$
				R L		$	$
				R L		$	$
				R L		$	$

Method of Payment                                                                            Sub Total ________
__ Check/Money order to Champion Athletics                                      Shipping ________
__ Visa   __ Mastercard    __ American Express    __ Discover            TOTAL $________

Credit Card Number       Expiration __ __/__ __                 Shipping
Authorized Signature :________________________           under $50              $7.00
                                                                                                under $100            $ 9.50
                                                                                                under $200            $ 12.00
                                                                                                under $300            $ 15.00
                                                                                                over $300              $ 18.50