Name : _________________________________ , Date : ________________

Address : ______________________________________________________

City : ________________________ State : _______________ Zip : ________

e-mail address : _________________________________________________

Home Phone : ______________________ Work Phone : _________________

Cell Phone : _______________________ Other phone : __________________

Amount Paid : $__________ + 8.25% Sale's Tax $ __________ = $_________

Macho Head - Size : M.   L.   XL.    ( Circle one )

Macho Chop - Size : CHM.    CHL.    S.    M.    L.    XL.    ( Circle one )

Macho Kick - Size :  CHM.    CHL.    S.    M.    L.    XL.    ( Circle one )