Pro Shop Gold Program 2015 Registration Form
Pro Shop Name: ____________________________
Owner: ___________________________________ Address: __________________________________
City: ______________ State: ______ Zip: ________
Phone:_______________ Fax:_________________
Email: ____________________________________ (submission of email implies consent to receive emails from the brands of Ebonite International.)
Returning Member: ____Yes ____No
Customer # (if yes to above): __________________
INFORMATION
BILLING/MAILING ADDRESS
Gold - Free
Gold Preferred - $295
Gold Preferred Plus - $595
____ Same as above
Address: __________________________________
City: _______________ State: _____ Zip: ________
CREDIT CARD INFORMATION
Name on Card: _____________________________
Card Number: _____________________________
Exp. Month: ___________ Exp. Year: ___________
Security Code: __________
CC Billing Address: _________________________
City: ______________ State: ____ Zip:_______
____ Visa ____ Mastercard ____ Amex
PROGRAM SELECTION
By selecting the Gold Preferred option, you are entitled to receive TWO branded shirts. Please indicate size and brand(s) below:
_____Columbia 300 _____ Size _____ Qty
_____ Ebonite _____ Size _____ Qty
_____ Hammer _____ Size _____ Qty
_____ Track _____ Size _____ Qty
Please select FOUR unique balls from our current catalog.
_____________________________ Ball #1 ________ Weight
_____________________________ Ball #2 ________ Weight
_____________________________ Ball #3 ________ Weight
_____________________________ Ball #4 ________ Weight
By selecting the Gold Preferred Plus option, you are entitled to receive TWO branded shirts. Please indicate size and brand(s) below:
_____Columbia 300 _____ Size _____ Qty
_____ Ebonite _____ Size _____ Qty
_____ Hammer _____ Size _____ Qty
_____ Track _____ Size _____ Qty
Please select FOUR unique balls from our current catalog. You will be able to select FOUR additional balls in July.
_____________________________ Ball #1 ________ Weight
_____________________________ Ball #2 ________ Weight
_____________________________ Ball #3 ________ Weight
_____________________________ Ball #4 ________ Weight
Mail Completed form to: ATTN: Pro Shop Gold Ebonite International, Inc. P.O. Box 746 Hopkinsville, KY 42241-0746 by FAX: 1-270-881-1201 by email: [email protected]
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