To order supplies:

* Fill out this form

* Allow two weeks for delivery

* Mail check or money order to:

American Kickboxing

90 N. Baldwin Ave #6

Sierra Madre, CA 91024

(626) 836-0445

Customer Name:________________________ Phone:_____________

Address:_______________________________

City:____________________ State:______________ Zip:________

                                                     Sub-Total:________________

                                                     Tax (x .0825):_____________

                                                    Shipping:                       $10.00  

                                                   TOTAL:__________________