We've provided this printable form for you to either mail in or fax us your order for the ThrowMAX.com Flexible Arm Brace.

Quantity Size  Height and Weight Left Right Extra Small Wt: up to 79lbs Ht: up to 4' 7" Small Wt: 80lbs-105lbs Ht: 4' 8"-5' 2" Medium Wt: 110lbs-145lbs Ht: 5' 3"-5' 8" Large Wt: 150lbs and up Ht: 5" 9" and up Total number of braces x $39.95 Add $5.95 for Shipping and Handling Washington residents please add 8.6% sales tax Total Price

League Affiliation:___________________________ District: ___________________________________ Local: ____________________________________ Age:_______________ Level of Play: ___________ Are you a: Coach: _______ Parent: _______ How did you hear about ThrowMAX.com: ____________________________________ ____________________________________ ____________________________________ Date of order: ____________________________

Please input in the following fields as they appear on your credit card. Name First:_______________________________________ Middle Initial: ________ Last:________________________________________________________________ Card holder Address:________________________________________________________________ City:_______________________________ State:________ Zip:_____________ Shipping Address: ________________________________________________________________ City:_______________________________ State:________ Zip:_____________ Phone Number Work:_____________________________ Home:_____________________________ Email Address:________________________________________________________________ Payment Type: __Master Card __Visa __Check __Money Order Credit Card Number:________________________________________________ Expiration Date:__________ Month:__________ Year:__________ Mailing Address: ThrowMAX.com 9225 NE 5th St. Bellevue, WA 98004 Phone Number: 425-591-7612