Golf Impact Tape Order Form

PURCHASED BY:

First Name Last Name

Street Address City

State Zip

Phone #

Email Address (*Required Field- Need so I can send confirmation)

PAYMENT METHOD:

Secure Server

American Express Visa Mastercard Discover

Card Holders Name

Credit Card Number Expiration (example- 07/02)

SELECT ITEM: (Free Shipping on items below)

Package of 30 impact labels - $10.00 Package of 90 impact labels - $25.00 Package of 150 impact labels - $40.00

Appropriate sales tax rate will be added to California orders.

MAIL TO:

Purchaser-address above

Address Below

First Name Last Name

Street Address: City

State Zip