![]() Please print and fill in then mail or fax to us. Fax: (08) 9592 9109 Surf Mania Shop 1 "The Boardwalk" 7 Railway Terrace Palm Beach WA 6168 Name:_____________________________________________________________________ Address:__________________________________________________________________ ___________________________________________________Tel:___________________ Shop:______________________________________________Tel:___________________ Surfing experince:_________________________________Waves surfed:__________ Shaper:___________________________________________________________________ Weight:_________________Age:______________________Height:_________________ Length:_________________Width:____________________Thickness:______________
Date:______________________________Desposit:_________________________ Price:_____________________________Balance:__________________________ |
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