MERCHANDISE ORDER FORM Items and Prices Effective February 10th, 2016 and Are Subject to Change Without Notice BILLING INFORMATION NAME (Club or Individual) US Figure Skating ID# ADDRESS CITY STATE ZIP DAYTIME PHONE OR EMAIL (We will contact you if we have a question concerning your order.) SHIPPING INFORMATION (If different from above) NAME (Club or Individual) COMMERICAL RESIDENTIAL US Figure Skating ID# ADDRESS CITY STATE ZIP DAYTIME PHONE OR EMAIL (We will contact you if we have a question concerning your order.) U.S. Figure Skating Accepts Checks, Money Orders, Visa, Mastercard, Discover, and American Express ** U.S. FIGURE SKATING MEMBERS MAY ORDER ONLINE VIA THE MEMBERS ONLY ONLINE STORE** Call, Fax, or E-Mail Your Credit Card Orders to: Order Line (719) 228-3468 Order Fax Line (877) 735-4824 Orders@usfigureskating.org Please Make Checks Payable to: U.S. Figure Skating 20 First Street Colorado Springs, CO 80906 Credit Card Number Name on Card Signature Exp Date Sec Code Order Total (including tax and Adm Fee) Rev: February 10th, 2016 1
U.S. Figure Skating Test Patches Code Description Qty Item Price Item Total Code Description Qty Item Price Item Total PB0201 Pre Preliminary Moves Patch PB0901 Adult Bronze Figure Patch PB0202 Preliminary Moves Patch PB0902 Adult Silver Figure Patch PB0203 Pre Juvenile Moves Patch PB0903 Adult Gold Figure Patch PB0204 Juvenile Moves Patch PB1001 Adult Pre Bronze Free Skating Patch PB0205 Intermediate Moves Patch PB1002 Adult Bronze Free Skating Patch PB0206 Novice Moves Patch PB1003 Adult Silver Free Skating Patch PB0207 Junior Moves Patch PB1004 Adult Gold Free Skating Patch PB0208 Senior Moves Patch PB1099 Adult Pre Bronze Dance Patch PB0301 Pre Preliminary Free Skatng Patch PB1100 Adult Bronze Dance Patch PB0302 Preliminary Free Skating Patch PB1101 Adult Pre Silver Dance Patch PB0303 Pre Juvenile Free Skating Patch PB1102 Adult Silver Dance Patch PB0304 Juvenile Free Skating Patch PB1103 Adult Pre Gold Dance Patch PB0305 Intermediate Free Skating Patch PB1104 Adult Gold Dance Patch PB0306 Novice Free Skating Patch PB1401 Maters Pre Bronze Dance Patch PB0307 Junior Free Skating Patch PB1402 Masters Bronze Dance Patch PB0308 Senior Free Skating Patch PB1403 Master Pre Silver Dance Patch PB0400 Pre Juvenile Pairs Patch PB1404 Masters Silver Dance Patch PB0401 Pre Pairs Patch PB1405 Masters Pre Gold Dance Patch PB0402 Juvenile Pairs Patch PB1406 Masters Gold Dance Patch PB0403 Intermediate Pairs Patch PB1407 Masters Pre Bronze Free Dance Patch PB0404 Novice Pairs Patch PB1408 Masters Bronze Free Dance Patch PB0405 Junior Pairs Patch PB1409 Masters Silver Free Dance Patch PB0406 Senior Pairs Patch PB1410 Masters Gold Free Dance Patch PB0501 Pre Dance Patch PB1413 International Dance Patch PB0502 Pre Bronze Dance Patch PB1415 Masters Solo Pre Bronze Dance Patch PB0503 Bronze Dance Patch PB1416 Masters Solo Bronze Dance Patch PB0504 Pre Silver Dance Patch PB1417 Masters Solo Pre Silver Dance Patch PB0505 Silver Dance Patch PB1418 Masters Solo Silver Dance Patch PB0506 Pre Gold Dance Patch PB1419 Masters Solo Pre Gold Dance Patch PB0507 Gold Dance Patch PB1420 Masters Solo Gold Dance Patch PB0601 Juvenile Solo Free Dance $3.00 PB1501 Adult Bronze Pair Patch PB0602 Intermediate Solo Free Dance $3.00 PB1502 Adult Silver Pair Patch PB0603 Novice Solo Free Dance $3.00 PB1503 Adult Gold Pair Patch PB0604 Junior Solo Free Dance $3.00 PB1601 Adult Pre Bronze Moves Patch PB0605 Senior Solo Free Dance $3.00 PB1602 Adutl Bronze Moves Patch PB0700 Juvenile Free Dance Patch PB1603 Adutl Silver Moves Patch PB0701 Intermediate Free Dance Patch PB1604 Adult Gold Moves Patch PB0702 Novice Free Dance Patch PB1700 Adult Solo Pre Bronze Dance Patch PB0703 Junior Free Dance Patch PB1701 Adult Solo Bronze Dance Patch PB0704 Senior Free Dance Patch PB1702 Adutl Solo Pre Silver Dance Patch PB0801 Solo Pre Dance Patch PB1703 Adult Solo Silver Dance Patch PB0802 Solo Pre Bronze Dance Patch PB1704 Adult Solo Pre Gold Dance Patch PB0803 Solo Bronze Dance Patch PB1705 Adult Solo Gold Dance Patch PB0804 Solo Pre Silver Dance Patch PB1706 Adult Pre Bronze Free Dance Patch PB0805 Solo Silver Dance Patch PB1707 Adult Bronze Free Dance Patch PB0806 Solo Pre Gold Dance Patch PB1708 Adult Silver Free Dance Patch PB0807 Solo Gold Dance Patch PB1709 Adult Gold Free Dance Patch PB0901 Adult Bronze Figure Patch PB1710 Adult International Dance Patch PB1711 Masters International Dance Patch PB2001 U.S. Figure Skating Patch PAGE 2 SUBTOTAL Rev: February 10th, 2016 2
U.S. Figure Skating Test Pins, Bars, and Medals Code Description Qty Item Price Item Total Code Description Qty Item Price Item Total EM0201 Pre Preliminary Moves Pin EM0903 Adult Gold Figure Medal EM0202 Preliminary Moves Pin EM1001 Adult Pre Bronze Free Skating Bar EM0203 Pre Juvenile Moves Pin EM1002 Adult Bronze Free Skating Medal EM0204 Juvenile Moves Pin EM1003 Adult Silver Free Skating Medal EM0205 Intermediate Moves Pin EM1004 Adult Gold Free Skating Medal EM0206 Novice Moves Medal EM1099 Adult Pre Bronze Dance Pin EM0207 Junior Moves Medal EM1100 Adult Bronze Dance Medal EM0208 Senior Moves Medal EM1101 Adult Pre Silver Dance Bar EM0301 Pre Preliminary Free Skatng Pin EM1102 Adult Silver Dance Medal EM0302 Preliminary Free Skating Pin EM1103 Adult Pre Gold Dance Bar EM0303 Pre Juvenile Free Skating Pin EM1104 Adult Gold Dance Medal EM0304 Juvenile Free Skating Pin EM1401 Master Pre Bronze Dance Pin EM0305 Intermediate Free Skating Pin EM1402 Master Bronze Dance Medal EM0306 Novice Free Skating Medal EM1403 Master Pre Silver Dance Bar EM0307 Junior Free Skating Medal EM1404 Master Silver Dance Medal EM0308 Senior Free Skating Medal EM1405 Master Pre Gold Dance Bar EM0400 Pre-Juvenile Pairs Pin EM1406 Master Gold Dance Medal EM0401 Pre Pairs Pin EM1407 Master Intermediate Free Dance Pin EM0402 Juvenile Pairs Pin EM1408 Master Bronze Free Dance Bar EM0403 Intermediate Pairs Pin EM1409 Master Silver Free Dance Bar EM0404 Novice Pairs Medal EM1410 Master Gold Free Dance Bar $67.00 EM0405 Junior Pairs Medal EM1413 International Dance Gold Medal EM0406 Senior Pairs Medal EM1414 Master Pre Bronze Free Dance Pin EM0501 Pre Dance Pin EM1415 Master Solo Pre Bronze Dance Pin EM0502 Pre Bronze Dance Pin EM1416 Master Solo Bronze Dance Medal EM0503 Bronze Dance Medal EM1417 Master Solo Pre Silver Dance Bar EM0504 Pre Silver Dance Bar EM1418 Master Solo Silver Dance Medal EM0505 Silver Dance Medal EM1419 Master Solo Pre Gold Dance Bar EM0506 Pre Gold Dance Bar EM1420 Master Solo Gold Dance Medal EM0507 Gold Dance Medal EM1501 Adult Bronze Pair Medal EM0601 Juvenile Solo Free Dance Pin EM1502 Adult Silver Pair Medal EM0602 Intermediate Solo Free Dance Pin EM1503 Adult Gold Pair Medal EM0603 Novice Solo Free Dance Pin EM1601 Adult Pre Bronze Moves Bar EM0604 Junior Solo Free Dance Pin EM1602 Adult Bronze Moves Medal EM0605 Senior Solo Free Dance Pin EM1603 Adult Silver Moves Medal EM0700 Juvenile Free Dance Pin EM1604 Adult Gold Moves Medal EM0701 Intermediate Free Dance Pin EM1700 Adult Solo Pre Bronze Dance Pin EM0702 Novice Free Dance Bar EM1701 Adult Solo Bronze Dance Medal EM0703 Junior Free Dance Bar EM1702 Adult Solo Pre Silver Dance Bar EM0704 Senior Free Dance Bar $67.00 EM1703 Adult Solo Silver Dance Medal EM0801 Solo Pre Dance Pin EM1704 Adult Solo Pre Gold Dance Bar EM0802 Solo Pre Bronze Dance Pin EM1705 Adult Solo Gold Dance Medal EM0803 Solo Bronze Dance Medal EM1706 Adult Pre Bronze Free Dance Pin EM0804 Solo Pre Silver Dance Bar EM1707 Adult Bronze Free Dance Bar EM0805 Solo Silver Dance Medal EM1708 Adult Silver Free Dance Bar EM0806 Solo Pre Gold Dance Bar EM1709 Adult Gold Free Dance Bar $67.00 EM0807 Solo Gold Dance Medal EM1710 Adult International Dance Medal EM0901 Adult Bronze Figure Medal EM1711 Master International Dance Medal EM0902 Adult Silver Figure Medal GS2201 U.S. Figure Skating logo pin PAGE 3 SUBTOTAL Rev: February 10th, 2016 3
Manuals and Miscellaneous Items Code Description Qty Item Price Price Total MN2406 MN2409 MN2413 MN2414 MN2415 MN2416 MN2425 I.S.U Constitution & General Regulations I.S.U Special Regulations - Synchronized Team I.S.U. Judges Handbook - Pairs Skating I.S.U. Judges Handbook - Singles I.S.U. Judges Handbook - Ice Dancing I.S.U. Synchronized Skating Judges Handbook I.S.U. Special Regulations - Single, Pairs, and Ice Dance MN-2600 Collegiate Guides - Set of 20 $25.00 SKATING Magazine Single/Back Issues Month/ Year JAN FEB MAR APRIL MAY JUNE/JULY AUG/SEPT OCT NOV DEC 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Shaded Areas are Unavailable Code Description Qty Item Price Price Total SKATING magazine single/back issues - please indicate the quanity needed for each issue in the appropriate box(s) SKBACK above $3.00 PAGE 4 SUBTOTAL Items and Prices Effective June 26, 2014 and Are Subject To Change Without Notice Administration Fee for Transactions Transaction Amount $0.00 - $33.01 - $100.00 $100.01 - $250.00 $250.01 - $500.00 $500.01 - $1000.00 $1000.01 - $2000.00 $2000.01 - $3000.00 $3000.01 - $4000.00 $4000.01 - $5000.00 $5000.01+ Administration Fee Credit Card $3.00 $7.50 $30.00 $60.00 $90.00 $120.00 3% Check City of Colorado Springs 8.25% El Paso County 4.90% Colorado State 3.90% SALES TAX *** Residents of CO must pay one of the following tax rates *** MERCHANDISE TOTAL SALES TAX (CO residents only) SHIPPING - DETERMINED AT TIME OF ORDER PROCESSING ADMINISTRATION FEE (See Table Above) TOTAL Rev: February 10th, 2016 4
Rev: February 10th, 2016 5