American Safety/ASHP: Helmet Order Form

SafeGuard™ Swift 20 Bicycle Helmet

▪ Slide Guide perfect fit

▪ Meets CPSC Bicycle Standards

▪ Sculpted Dynamic Design

▪ Nexus Buckle, On Visor

Pkg^*	Size^**	Color(s)^***	Price	Total
32	Small 19.68"-21.25"	Red Blue Silver Mixed (even mix, all colors) Mixed (specify below)	$8.69	$
28	Medium 21.25"-22.83"	Red Blue Silver Mixed (even mix, all colors) Mixed (specify below)	$8.69
28	Large 22.83"-24.4"	Red Blue Mixed (even mix, all colors) Mixed (specify below)	$8.69
The Freight Cost Will Be Added To Your Order. The freight cost for helmets delivered within the Contiguous U.S. is $1.25/helmet.			$1.25
Special instructions, such as mixed colors:			Subtotal for this item:	$

Minimum order is 40 helmets.
^* Pkg: The number of helmets per carton.
^** Size: The size measurements are the head circumference, as measured, approx. two fingers above the wearers eye brows and parallel to the ground.
^*** Colors(s): For mixed colors, if we are out of stock on any color(s) we will fill the order with available colors unless otherwise directed.
⁺ Qty.: Number of helmets.

SafeGuard™ 9 Bicycle Helmet

▪ Flash Graphics

▪ Meets CPSC Bicycle Standards

▪ Instant fitting with turn ring system

▪ Pinch Guard, Snap-on Visor

▪ Full picture

Pkg^*	Size^**	Color(s)^***	Price	Total
24	Small 19.68"-21.25"	Red Blue Silver Mixed (even mix, all colors) Mixed (specify below)	$7.50	$
24	Medium 21.25"-22.83"	Red Blue Silver Mixed (even mix, all colors) Mixed (specify below)	$7.50
20	Large 22.83"-24.4"	Red Blue Silver Mixed (even mix, all colors) Mixed (specify below)	$7.50
20	X-Large 23.22"-24.8"	Red Blue Silver Mixed (even mix, all colors) Mixed (specify below)	$7.50
The Freight Cost Will Be Added To Your Order. The freight cost for helmets delivered within the Contiguous U.S. is $1.25/helmet.			$1.25
Special instructions, such as mixed colors:			Subtotal for this item:	$

SafeGuard™ 8 Bicycle Helmet

▪ Solid Colors

▪ Meets CPSC Bicycle Standards

▪ Occipital Lobe Retention System

▪ Snap-on Visor

▪ Full picture

Pkg^*	Size^**	Color(s)^***	Price	Total
28	Small 19.68"-21.25"	Red Blue Black Purple Mixed (even mix, all colors) Mixed (specify below)	$6.50	$
28	Medium 21.25"-22.83"	Red Blue Black Purple Mixed (even mix, all colors) Mixed (specify below)	$6.50
24	Large 22.83"-24.4"	Red Blue Black Purple Mixed (even mix, all colors) Mixed (specify below)	$6.50
20	X-Large 23.22"-24.8"	Blue Only	$6.50
The Freight Cost Will Be Added To Your Order. The freight cost for helmets delivered within the Contiguous U.S. is $1.25/helmet.			$1.25
Special instructions, such as mixed colors:			Subtotal for this item:	$

SafeGuard™ 11 MultiSport Helmet Authentic Dual-Certified

Skateboard, Inline Skating, Rafting, Skiing, Rock Climbing

▪ Meets ASTM F1492 Skateboarding & Skating Standards

▪ Meets CPSC Bicycle Standards

▪ Full picture

Pkg^*	Size^**	Color(s)^***	Price	Total
10	Small 21.25"-22.04"	Black White Blue Mixed (even mix) Mixed (specify below)	$10.85	$
10	Medium 22.44"-23.22"	Black White Blue Mixed (even mix) Mixed (specify below)	$10.85
10	Large 23.6"-24.4"	Black White Blue Mixed (even mix) Mixed (specify below)	$10.85
10	X-Large 24.8"-25.59"	Black White Blue Mixed (even mix) Mixed (specify below)	$10.85
The Freight Cost Will Be Added To Your Order. The freight cost for helmets delivered within the Contiguous U.S. is $1.25/helmet.			$1.25
Special instructions, such as mixed colors:			Subtotal for this item:	$

Minimum order is 30 helmets for MultiSport.
^* Pkg: The number of helmets per carton.
^** Size: The size measurements are the head circumference, as measured, approx. two fingers above the wearers eye brows and parallel to the ground.
^*** Colors(s): For mixed colors, if we are out of stock on any color(s) we will fill the order with available colors unless otherwise directed.
⁺ Qty.: Number of helmets.

SafeGuard™ 10
MultiSport Style Only Helmet

▪ Meets CPSC Bicycle Standards

▪ NOT MultiSport Certified

▪ Full picture

Pkg^*	Size^**	Color(s)^***	Price	Total
10	X-Small 20"-21"	Sparkle Blue Red Black Mixed (even mix) Mixed (specify below)	$8.60	$
10	Small/Medium 21.5"-22.5"	Sparkle Blue Red Black Mixed (even mix) Mixed (specify below)	$8.60
10	Large/X-Large 22.75"-24.5"	Sparkle Blue Red Black Mixed (even mix) Mixed (specify below)	$8.60
The Freight Cost Will Be Added To Your Order. The freight cost for helmets delivered within the Contiguous U.S. is $1.25/helmet.			$1.25
Special instructions, such as mixed colors:			Subtotal for this item:	$

Minimum order is 30 helmets for Multisport.
^* Pkg: The number of helmets per carton.
^** Size: The size measurements are the head circumference, as measured, approx. two fingers above the wearers eye brows and parallel to the ground.
^*** Colors(s): For mixed colors, if we are out of stock on any color(s) we will fill the order with available colors unless otherwise directed.
⁺ Qty.: Number of helmets.

SafeGuard™ 6 Bicycle Helmet

▪ Low Price

▪ Meets CPSC Bicycle Standards

▪ Customized Fit Pad Set

▪ Full picture

Pkg^*	Size^**	Color(s)^***	Price	Total
24	Small 19.68"-21.25"	Blue Only	$5.50	$
24	Medium 21.25"-22.83"	Blue Only	$5.50
20	Large 22.83"-24.4"	Blue Only	$5.50
The Freight Cost Will Be Added To Your Order. The freight cost for helmets delivered within the Contiguous U.S. is $1.25/helmet.			$1.25
Special instructions, such as mixed colors:			Subtotal for this item:	$

Minimum order is 40 helmets.
^* Pkg: The number of helmets per carton.
^** Size: The size measurements are the head circumference, as measured, approx. two fingers above the wearers eye brows and parallel to the ground.
Colors(s): For mixed colors, if we are out of stock on any color(s) we will fill the order with available colors unless otherwise directed.
⁺ Qty.: Number of helmets.

SafeGuard™ 5db Duck-bill Toddler Bicycle Helmet

▪ Eight top vents keep little heads extra cool

▪ PinchGuard buckle for no-pinch buckling

▪ Meets CPSC Standards

▪ Full picture

Pkg^*	Size^**	Color(s)^***	Price	Total
26	Toddler 19.29"-20.47"	Pink Graphic Only	$7.50	$
The Freight Cost Will Be Added To Your Order. The freight cost for helmets delivered within the Contiguous U.S. is $1.25/helmet.			$1.25
Special instructions, such as mixed colors:			Subtotal for this item:	$

SafeGuard™ 5 Toddler Bicycle Helmet

▪ Adjustable SNUGFIT Retention System

▪ Cool Fun Graphics

▪ Meets CPSC Standards

▪ Full picture

Pkg^*	Size^**	Color(s)^***	Price	Total
26	Toddler 18"-20.5"	Blue Graphic Pink Graphic Mixed (even mix, both colors) Mixed (specify below)	$7.50	$
The Freight Cost Will Be Added To Your Order. The freight cost for helmets delivered within the Contiguous U.S. is $1.25/helmet.			$1.25
Special instructions, such as mixed colors:			Subtotal for this item:	$

Minimum order is 40 helmets.
^* Pkg: The number of helmets per carton.
^** Size: The size measurements are the head circumference, as measured, approx. two fingers above the wearers eye brows and parallel to the ground.
Colors(s): For mixed colors, if we are out of stock on any color(s) we will fill the order with available colors unless otherwise directed.
⁺ Qty.: Number of helmets.

SafeGuard™ 4 Toddler Bicycle Helmet

▪ Three Customized Fit Pad Sets

▪ Extended Coverage on Sides and Back

▪ Meets CPSC Standards

▪ Full picture

Pkg^*	Size^**	Color(s)^***	Price	Total
26	Toddler 19.3"-20.47"	Blue Pink Mixed (even mix, both colors) Mixed (specify below)	$6.50	$
The Freight Cost Will Be Added To Your Order. The freight cost for helmets delivered within the Contiguous U.S. is $1.25/helmet.			$1.25
Special instructions, such as mixed colors:			Subtotal for this item:	$

Minimum order is 40 helmets.
^* Pkg: The number of helmets per carton.
^** Size: The size measurements are the head circumference, as measured, approx. two fingers above the wearers eye brows and parallel to the ground.
Colors(s): For mixed colors, if we are out of stock on any color(s) we will fill the order with available colors unless otherwise directed.
⁺ Qty.: Number of helmets.

Order Total

We will correct this value if neccessary.

Subtotal:	$
Minimum Order Charge If your order total, including freight, is less than $500, please add $25 to your order.
Order Total:	$

BILL TO:

Company:
Attention:
Address:
City:
State:
Zip:
Country:

SHIP TO:

If different.

Company:
Attention:
Address:
City:
State:
Zip:
Country:

METHOD OF PAYMENT:

Method:

Visa

MasterCard

Prepay

Bill Us

Name on Card:

(as it appears on your card)

Zip:

(your card statement mails to)

Card Number:

Card Expiration:

Signature:

__________________________ (if offline)

ORDER IDENTIFICATION:


Purchase Order No.:
Ordered by:
Order Date:
Phone Number(s):
Fax Number:
Email:
Special Instructions:
Contact me for approval, if you are not able to fill my order exactly.

Toll-free	1-888-BUY-ASHP, or 1-888-289-2747
FAX (434) 977-0111, or Phone (434) 977-2700
Home Page: www.buyashp.com

American Safety/ASHP Helmets

SafeGuard™ Swift 20 Bicycle Helmet

SafeGuard™ 9 Bicycle Helmet

SafeGuard™ 8 Bicycle Helmet

SafeGuard™ 11 MultiSport Helmet Authentic Dual-Certified

Skateboard, Inline Skating, Rafting, Skiing, Rock Climbing

SafeGuard™ 10 MultiSport Style Only Helmet

SafeGuard™ 6 Bicycle Helmet

SafeGuard™ 5db Duck-bill Toddler Bicycle Helmet

SafeGuard™ 5 Toddler Bicycle Helmet

SafeGuard™ 4 Toddler Bicycle Helmet

Order Total

BILL TO:

SHIP TO:

METHOD OF PAYMENT:

ORDER IDENTIFICATION:

SafeGuard™ 10
MultiSport Style Only Helmet