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ORDER FORM – CUSTOM BELTS

Please complete and submit the fully completed order form. Your belt order will be confirmed by a service representative.
Payment options include Visa, MasterCard, by telephone once order has been confirmed.

 

Your Name : 
Address : 
City : 
State/Province : 
Zip/Postal Code : 
Country: : 
Telephone home : 
Cell/Mobile : 
Your Email Address : 

 

Style : 
Number of years training : 
Club : 
Rank : 

 

INFORMATION BELOW REQUIRED ONLY FOR CUSTOM BELTS

 

FINISHED BELT LENGTH - INCHES or CM : 

 

FABRIC CHOICE– Black : 
 SILK  COTTON
FOR CHECKER : 
 Red/black combination  Red/white combination

 

EMBROIDERY ABOVE LABEL : 

(This can include Kanji, Style, or Association or Federation Kanji)

 

EMBROIDERY- Name : 

(Select from name translated to Katakana, Japanese characters for Non-Japanese names
Name in - Script font, running horizontally, read sideways on belt,
Name in - Block letters, runs vertically, reads from top down)

 

EMBROIDERY – Colour of thread : 

(Choose from Antique Gold, Silver, White, Red, Black, Copper, Yellow, etc…)

 

RANK/TITLE - in Kanji : 

 

RANK/STRIPES - Number of stripes : 

LOCATION of stripes -

Above Label : 
Below Name : 
Additional Information : 
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