To Order using this form: print out the form, filling out information and either

send by mail to: POB 296, Brookfield, MA 01506 or fax to: (508) 867-8097

PAY BY: ________ Check (enclosed) __________ Charge ________ Invoice (must have established account)

  Online Ordering by PayPal available - see instructions below

We only charge your account for items in stock! Back-ordered items are charged when sent. You will be notified of any backorders.

ORDER INFORMATION: (We GUARANTEE we will give NONE of this information to ANYONE for ANY REASON!)

Marque, Model and Year of Motorcycle(s): ________________________________

E-mail address: _______________________________________________________

NAME: _____________________________________________________________

STREET ADDRESS: __________________________________________________

CITY, STATE, ZIP, COUNTRY: ________________________________________

Phone: ________________________ Fax: _________________________________

If Ship To address different, enter here: __________________________________

COMMENTS or SPECIFICATIONS: _____________________________________ (IF using PAYPAL, stop here)

If Charge Card address different, enter here: _______________________________

Charge Card Number: _________________________________________________ (do NOT email this info - this server is NOT secure - mail or fax it)

Expiration Date: ______________________________________________________

Quantity	Item #	Item Name	Price each	Total Price
		Prices do NOT include shipping or insurance –call for this price or, if charging order, leave blank and we'll fill in. If using PAYPAL call for price or we can let you know the shipping and that can be paid by PAYPAL also.
TOTAL
		Online Payment by PayPal available - FAX or email this form in addition to using PAYPAL for payment so we know what you ordered