First Name:	Last Name:		Initial
Address:
City:	State:		Zip:
Day Time Phone:	Email:
Warm-up Cost $	Embroidery Cost $	Total Cost $

Warm-up Jacket, Break away pants, Cap

Quantity	Item Description	Sizes (Circle)	Item Price	Extension
	9024 Performer Jacket Blk/Scar/white	S M L XL	$41.25	$ .
	9024 Performer Jacket Blk/Scar/white	XXL	$43.25	$
	9024 Performer Jacket Blk/Scar/white	XXXL	$45.25	$
	9014 Breakaway Pants Blk/Scar/White	S M XL	$30.25	$
	9014 Breakaway Pants Blk/Scar/White	XXL	$32.25	$
	9014 Breakaway Pants Blk/Scar/White	XXXL	$34.25

Total Warm-up $ ____________

Embroidery

Back of Jacket	$8.00
Logo, Left Chest	$4.00
Name or Initials	$3.00

Total Embroidery $ ____________

Warm-up Cost $

Embroidery Cost $

Total Cost $

Print Name or Initials Exactly as is to Appear on Jacket:

__________________________________________________________________________________

Signature_____________________________________________________ Date_________________

Make Check or Money Order Payable to: Trophy Sports Center

Submit Complete Form with Payment to: John Durr

Trophy Sports Center

2030 N Limestone St.

Springfield, Ohio 45503

Phone: 937-323-4918

Fax: 937-323-0301

Please allow 6 to 8 weeks for delivery