Sample Kit Form PLEASE COMPLETE THIS AUTHORIZATION FORM. FAX OR EMAIL IT TO OUR OFFICE. FAX: (713) 490-3159 E-MAIL [email protected] Payment Company/Team: Check payable to Scudo Sports Wear LLC. Contact Name: American Express Credit Card E-mail Mastercard Billing Address: Visa State City: Discover Zip/Postal Code: Card Number: Cell: Expiration Date: Phone: CCV number Fax: Cardholder Name: Mens Jerseys XS S M L XL 2XL 3XL Mens Shorts XS S M L XL 2XL 3XL Womens Jerseys XS S M L XL 2XL 3XL Womens Shorts XS S M L XL 2XL 4XL Total Amount Terms and Conditions 1. Price per item is $25.00. 2. You only can order one garment per size.(Jersey or Shorts) 3. We don't charge a shipping fee for delivery. 4. The customer is responsible for the cost of the return shipping. 5. The fee will be refunded once the kit is returned, or you can choose to have the amount credited towards your order. Comments: Scudo Sports Wear LLC Po Box 840768 Houston, TX 77084 USA 77084 Phone: 1 866 707 4495 Fax: (713) 490 3159 www.scudopro.com Card Holder Signature Date