Local Skate Shop

ORDER FORM

 

 

Name of skater :____________________

Age (if under 21) :___

Male / Female  :___

 

Do you skate at Sydney ice arena,  Solent Circuit Baulkham hills Sydney NSW         q Yes       q No

 

Optional - for our marketing purposes – Last test level achieved :______________

Disciplines (please tick) : q Freestyle       q Dance      q Syncro      q Pair   q Recreational

 

Delivery address:        __________________________

                                __________________________

                                __________________________

                                __________________________

 

Skates

Model  :___________________ ie Model Name or corresponding number (Gold Medallion 300)

Color   :_________

Size    :_____  (Please note that Australian street shoe sizes do not correspond with US Riedell Skate sizes,  please use our free sizing service).

Width  :______ 

 

Or measurements from sizing form on this web site

 

L1  (length)              :_______   CM / Inches

B1 (Ball circumference) :______ 

Allow room for growth   (None /   Half size   / full size   / other) please circle

(please note children's feet stop growing at age 13,  do not allow any room for growth for older children)

 

Blade    :_________________________

 

 

Contact name (ie parent’s name) :___________________

Phone Number :______________

Email address  :______________

 

Boots and blades                        $_________

Postage (allow 3 to 4 days)         $15 or

Express post (next day delivery) $35

 

Amount of order          $___________

 

 

• Payment by direct deposit / internet bank transfer 

Please attach direct deposit or internet transfer receipt to this order and fax through to 02 9383 8388

or

• Payment by credit card

 

Card holders name as it appears on card :_________________________

 

Signature :________________________________

 

All Local Skate Shop credit card and FPOS purchases will show on your statement as RentalPoint Software