Name:________________________________________________
Address_______________________________________________
City, State, Zip_________________________________________
Phone (_________)
_____________________________________
E-mail Address_________________________________________
Helmet (1)
Please let us know the team, school,
driver, or organization you would like to have the custom helmet kit to be
designed for
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Helmet (2)
Please let us know the team, school,
driver, or organization you would like to have the custom helmet kit to be
designed for
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
______________________________________________________
Total Cost of this order? $
________________
Method of Payment (check
one)?
_____Check Enclosed (form
must be mailed not faxed)
_____Credit Card
______________________________________________________
Credit Card Authorization
FOR
YOUR CONVENIENCE WE DO ACCEPT
_____ Amex _____
Visa _____ MasterCard _____ Discover
Card Number:
_________________________________
Exp. Date:_________________
Zip Code: ___________
Name on
Card:________________________________
HELMET KITS ARE CUSTOM MADE. PLEASE ALLOW 6-8 WEEKS FOR
DELIVERY!
Fire Fanatic is an independent 3rd party organization and is
no way affiliated with the business aspect of Campus Fire Safety. Please use
all contact information listed above to contact Fire Fanatic should you
have any questions or comments.
______________________________________________________
