Place Your Order Here

Use the following form to place your facemask reconditioning order.

Fill out the form and submit. You will be immediately sent a copy of your order information to the email you provide. Print a copy of this email for your records and a second copy to place in the box with your order.

Name
First Last
Contact Email Address*
Enter Email Confirm Email

Enter a valid email addres at which to contact you and send confirmation of your order.
Organization or School
Phone*
Alternate Phone
in case we can't reach you at your regular phone number, is there another at which you can be reached?
Billing Information:*
Street Address Address Line 2 City State ZIP Code

Please enter your SHIPPING INFORMATION if it's different than your BILLING ADDRESS. (Don't worry about your information - we will not spam you nor put you on a mailing list, unless you wish to sign up for our Newsletter for information about specials and news in the Industry.)
Shipping Information:
Street Address Address Line 2 City State ZIP Code
How'd you hear about us?
PAYMENT METHOD:
Please select one of these Payment Methods:*
- Check
- Cash
- Credit Card (2% extra fee required)
Remind us if we have made other Payment arrangements already...
Purchase Order Number
ORDER INFORMATION:
#of XENITH
#of SCHUTT
#of RIDDELL
#of XP/ASSORTED
#of OTHER
If your type of mask is not listed enter number of OTHER here
Total facemasks to be reconditioned*
This field will be caulculated automatically depending on values you enter for specific facemask models above.
Number of boxes in shipment*
Color Chart
Color of facemasks
Specific Requests/Comments:
Print Your Name*
Date
MM slash DD slash YYYY
Signature*
Use your mouse or touch screen to write your signature. If you need to start over, simply click the circular erase button below and try again.
PAYMENT AGREEMENT: By signing above, I authorize West Coast Facemasks (WCFM) to recondition and recertify the above order. I understand that payment must be received before WCF will return my completed order, unless previous arrangements have been made.
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Place Your Order Here

Use the following form to place your facemask reconditioning order.

Fill out the form and submit. You will be immediately sent a copy of your order information to the email you provide. Print a copy of this email for your records and a second copy to place in the box with your order.

PAYMENT METHOD:

ORDER INFORMATION:

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