Protective Helmet Information Request

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*Your name:
*E-Mail:

Address:
City/Town:
Province:
Postal Code:
*Country:

*Phone:
Fax:

For ease of submission of product details are you able to gain access to a fax machine, if you do not already have one personally?

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If interested in a specific model please indicate below:

The "Skullguard" (ultra light-weight head protectors) Full coverage soft shell helmet (available outside USA only)

Please indicate any specific features that you may be interested in (some may not be available on the above models):

Ventilation for top of head Chin guard protection Forehead bumper extension as partial protection of the nose. Rigid ear covers (on hard shell helmets only) Extra protection down the nape of the neck (on soft and hard shell helmets) Hard shell main construction for maximum protection of the skull Helmet covers for partial disguise Soft pliable and lightweight leather helmet with optional chin guard - forehead bumper and nape of the neck bumper Black deluxe hard shell helmet - basic construction with aesthetic non-functional peak Full-coverage soft shell foam construction with partial cheek and back of head protection Halo helmet with protection around the skull but no top of head protection for maximum ventilation Plastazote construction Plastazote construction with external ABS extra protection Custom-made scrum type leather helmet Plastazote construction with forehead extension for extra nose protection and with optional rear bumper Moulded plastazote helmet unlined Moulded plastazote helmet with leather lining

Questions/Comments (please indicate the head circumference measurement, if available):

Completed forms will be forwarded to a representative who will contact you directly with some recommendations given these preliminary factors. Please note that this process can take up to a couple of weeks.

In North America, you can also find out more information, or follow up this form, by contacting David Sampano at 1-800-268-0184 (toll-free) or <david.sampano@stevens.ca>.

The purpose of this is to educate the public on what is available and how it might help. There is no obligation to purchase anything.

The information provided on this form will only be kept for our records and will not be shared with any other parties.

Click the "Submit" button below to send this form.