Individual Items

SUMMER 18/19 SEASON
Central City BREAKERS
Order Form

1. Reversible Playing Singlets $100.00
2. Shorts $45.00
3. Playing Uniform $100.00
4. Warm u top or hoodie $50.00
5. Printed Tee Shirt $20.00
6. Beanie $15.00
7. Bag with Name $50.00
8. Backpack with Name $50.00
9. Hand towel with emb club logo $15.00
10. Polo Sublimated $40.00
11. Breakers Socks Royal 1 pair $15.00
2 pair $25.00
12. Spalding basketball with pack $35:00
separate $50:00

Date

Player's Name

Delivery Address

Players Date of Birth

Sex

Male Female

Parent's / Guardian's Name

Singlet Number Now:

Requested Number

Singlet Number Club Allocated

Please select which items / sizes you would like to purchase

Reversible Singlet $65

Shorts $45

Tee Shirt $20

Warm Up Top $50

Name on Warm Up Top

Hoodie $50

Name on Hoodie

Backpack $50

Name on backpack

Bag $50

Name on bag

Beanie $15

Hand Towel $15

Polo Sublimated $40

Socks (1 pair $15.00 2 pair $25.00)

Spalding Basketball ($35.00 with pack or $50 separate)

Delivery $10

Payment Method

If paying by card, then please complete the following:

Name on Card

Card Number

Expiry Month

Expiry Yr

CVC

If paying by direct deposit please direct payment to:
Fiddes Sport
BSB: 063184
Account: 1042 8368
Please use code “CCB” followed by your SURNAME, on your bank transfer.

FIDDES SPORT
Phone: 03 9464 1721
Mobile: 0400 555 255
Address: Factory 15, 24 Brand Drive, THOMASTOWN, 3074
fiddes@fiddes.com.au

SUMMER 18/19 SEASON Central City BREAKERS Order Form

Please select which items / sizes you would like to purchase

FIDDES SPORT Phone: 03 9464 1721 Mobile: 0400 555 255 Address: Factory 15, 24 Brand Drive, THOMASTOWN, 3074 fiddes@fiddes.com.au

SUMMER 18/19 SEASON
Central City BREAKERS
Order Form

FIDDES SPORT
Phone: 03 9464 1721
Mobile: 0400 555 255
Address: Factory 15, 24 Brand Drive, THOMASTOWN, 3074
fiddes@fiddes.com.au