- Name Embroideried
- Belt Embroideried
United Stitch Associates
1143 Barford Ave.
Hacienda Heights, CA 91745
Tel: 626-333-3323
Fax:626-333-6611
E-mail: info@123patch.com


Order Form
 

- Any request beyond this order form, please call (800-842-6294) or e-mail us.
- Delivery time about 4 to 7 days after order confirmed.

Note: fields marked in * are required to process your order.

Please select one*:
No, use my own belt
Yes, I need the belt in:
Color Size Width
Belt Type:

1. Side one (label side):
line 1*: Language in English Chinese/Kenji Korean Japanese Katakana
Letter style in Regular bold Script Bamboo
Please type: Color:

line 2: Language in English Chinese/Kenji Korean Japanese Katakana
Letter style in Regular bold Script Bamboo
Please type: Color:

2. Side two:
line 1*: Language in English Chinese/Kenji Korean Japanese Katakana
Letter style in Regular bold Script Bamboo
Please type: Color:

line 2: Language in English Chinese/Kenji Korean Japanese Katakana
Letter style in Regular bold Script Bamboo
Please type: Color:

Special Instruction:

Billing Information
First Name*: Last Name*:
School Name*:
Mailing address*:
City*: State*: Zip Code*:
E-Mail Address*:
Tel*: Cell: Fex:

Credit Card Information
Card Type*: Visa Card Master Card America Express
Card No.*: ---
Exp. Date*: Month / Year



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