970 Lax Helmet Order Placement Form

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Please fill out all of the boxes below. When you are ready to submit, please send a Venmo (@noco970lax) payment of $260 if you want to purchase just the helmet or $280 if you want to purchase the helmet w/ custom decals. If you do not have a Venmo, please email joy@970lax.com so that we can confirm another form of payment. Thank you all!

Player First Name *

Player Last Name *

Parent First Name *

Parent Last Name *

Parent Email *

Parent Phone Number *

Parent Venmo Account (If you do not have Venmo, please just write, "I do not have Venmo" and we will reach out for other forms of payment) *

Would you like to purchase the 970 Lax Cascade XRS Helmet pictured below @ $260? *

Yes

970 Lax Cascade XRS One-Size-Fits-All Helmet