12U
Questionnaire
541 Division St. Building B Campbell, CA 95008
OFFICE: (408) 866-8050 FAX: (408) 866-8088
OFFICE: (408) 866-8050 FAX: (408) 866-8088Contact Information
Name:
Address:
City:
ZIP:
Phone:
Date of Birth:
Email Address:
Cell Phone:
Payment Information
Amount:
Credit Card Number:
Exp. Date:
Name On Card:
ZIP:
Billing Address:
CVV Code (back of card):
Baseball Information
Please select :
Position:
Pos 2:
Ht:
Wt:
Bats:
Throws:
School:
Grad Year:
GPA:
Top 3 jersey numbers:
Jersey Size:
Payment Schedules-Summer Session:
Cost: $750.00*** or Pay $250/Month for 3 months.
Monthly Payments Due: June 1 , July 1 , & August 1
If you choose the monthly payment plan you agree to pay all 3 payments for
a total of $975. Choose an option: Agree or Don't Agree
All Monthly Payments by: on-file credit card or Post-dated checks.
***plus $225 Deposit for uniforms & tournament fees.
(Please make sure to fill out credit card information).
Scholarship Needed:?
Scholarship % Needed
