Customer Order No:________________________________ Mail or Fax order to:
Action Surf Shop
PO Box 627
Atlantic Beach, NC 28512
Fax - 252-240-0153		  
  Name:___________________________________________

Street Address:___________________________________

City:____________________________________________

Phone:__________________________________________

e-mail:__________________________________________

 

    
  Board Specs:
Weight:______________________

Length:______________________

Shape: (circle one)
Fun Fish - Fun Shape - Short Board
Prototype - Performance Fish - Long Board

Fins: (circle one)
FCS - Future - Glass On - Other:_____________________

Decals:
Top:_____________________________________________

Bottom:__________________________________________

Color Design:______________________________________

_________________________________________________

_________________________________________________

Special Art Work:__________________________________

_________________________________________________

_________________________________________________