Standard Size Bicyclecart Order Form

1. Print this form   2. Fill it out   3. Fax to 574-534-8687

Full Name_______________________________________________

Shipping Address:_________________________________________

_______________________________________________________
Note: Your shipping and credit card billing address must be the same!

E-mail Address:__________________Phone Number________________

Telephone and/or fax number:________________________________

Circle card type:        Visa  /  MasterCard  / American Express /  Discover

Name as it appears on card:________________________________

Card Number:_____________________________________________

3 digit Card security code:___________ What is it?

Expiration Date:____________________________________________

 

Standard Size Bicycle Cart(s) x $250 each

Option #1
Waterproof Cover $23.50

Option #2
Aluminum Fenders $26.50

Option #3
Extra Hitch $12.00

Sub total:

Indiana Residence add 7% tax:

Shipping Costs:
(See standard cart shipping zones table)

Grand Total:

 

$___________


$___________


$___________

$___________

$___________

$___________


$ __________


$___________