USQRA Rugby Ball Order Form

Print out and fill in the form below. Once completed mail it with payment in full to the USQRA c/o John Bishop, 5861 White Cypress Drive, Lake Worth, Florida 33467-6230

If ordering from outside the US you are requested to fax or e-mail your order before sending payment to verify shipping fee's. Our 24 hour Fax number is 1 (561) 642-4444 E-mail jbishop@quadrugby.com.

Please provide the following shipping information:
First name: ___________________________________________
Last name: ___________________________________________
Organization: ___________________________________________
Shipping address: ___________________________________________
Address (cont.): ___________________________________________
City: ___________________________________________
State/Province: ___________________________________________
Zip/Postal code: ___________________________________________
Country: ___________________________________________
Home Phone: ___________________________________________
Work Phone: ___________________________________________
Fax Number: ___________________________________________
E-mail(important!): _____________________@____________________
Shipping is $5.00 per order in the US -   Number of balls ordered  

Balls with USQRA logo - $25 each
Note: Ball price is for USQRA members only. All others pay just $30.00 per ball

 

Payment Information
USQRA members and teams may pay by personal check, or money order. All others must pay by either money order or Electronic Bank Transfer (ask for details). Sorry, no credit cards can be accepted.
Form of Payment:
___________________________________________________
                                  Sorry, no credit cards accepted
Amount Enclosed:
___________________________________________________
International orders may pay by electronic bank transfer (ask for details) or by money order payable in US dollars.

Questions? Phone John Bishop at (561) 964-1712 from 8:00 a.m until 11:30 p.m. Eastern Daylight Time or send e-mail @ jbishop@quadrugby.com

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