ORDER PAGE

  SEE "LOCK" ON BOTTOM RIGHT SIDE OF BROWSER

WE ARE A SECURE SITE WITH RAPIDSSL  http://www.rapidssl.com/ssl-certificate-support/ssl-site-seal/rapidssl.htm

PLEASE ALLOW 3-7 BUSINESS DAYS FOR SHIPMENT

ANOTHER WAY TO USE THIS FORM IS TO FILL IT OUT AND PRINT IT AND---THEN FAX IT TO US TOLL-FREE:  1-866-766-0896

PLEASE VISIT ABOUT US BEFORE ORDERING:  SUBMITTING THIS ORDER FORM MEANS YOU AGREE TO THE ABOUT US TERMS

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WHEN SUBMITTED:  THIS ORDER PAGE IS SECURED WITH 128 BIT ENCRYPTION.  CHECK THIS BY NOTICE OF  THE LOCK EMBLEM AT THE BOTTOM OF RIGHT OF YOUR BROWSER PAGE

 (CHECK THE BOTTOM RIGHT-HAND CORNER FOR THE "LOCK")

PASTE YOUR PART IN THE BOX BELOW

PASTE YOUR PART IN THE BOX BELOW (HIGHLIGHT, CUT, AND PASTE OPTION)

YOU CAN PASTE OR TYPE IN EACH OF THESE BOXES

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HOW MANY DESCRIPTION

PRICE

-----

HOW MANY DESCRIPTION

PRICE

HOW MANY DESCRIPTION

PRICE

HOW MANY DESCRIPTION

PRICE

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WRITE ANY ADDITIONAL COMMENTS IN SPACE BELOW

  WE DO NOT ACCEPT ANY CARD ORDER AS SECOND PARTY.  YOU MUST BE THE CARDHOLDER AND SHIPMENT MUST BE TO THE PHYSICAL ADDRESS OF THE CARD'S BILLING ADDRESS (NO PO BOX ORDERS ACCEPTED)

  BILLING
Credit Card PICK ONE   WE DO NOT ACCEPT AMERICAN EXPRESS
Cardholder  Name 

 

 
Card Number   JUST THE NUMBERS, NO DASHES
Expiration Date   JUST THE NUMBERS, NO DASHES (0103, FOR EXAMPLE)

SHIPPING INFORMATION

ALL AREAS WITH    XXXXXXX COLOR IS REQUIRED FOR THE ORDER TO FUNCTION

*  REQUIRED INFORMATION

YOUR NAME*  
Street Address*  
Address (cont.)
City*  
State/Province*  
Zip/Postal Code*
Country*  

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CHOOSE ONE OF THE FOLLOWING SHIPPING OPTIONS (REQUIRED)

CHOOSE ONE BY CLICKING A SHIPPING OPTION

     

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APPROXIMATE SHIPPING COSTS:  UPS:  FOR APPROXIMATE SHIPPING COSTS GO TO http://www.ups.com:  USE 25419 AS THE ZIP CODE FROM MY END, ESTIMATE THE SHIPPING WEIGHT

FOR MAILED PACKAGES:  GO TO http://www.usps.com

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CHOOSE ONE ORDER OPTION (REQUIRED) 

 YOUR E-MAIL ADDRESS (REQUIRED)

YOUR CONTACT TELEPHONE WITH AREA CODE
 

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Hayes A. Hatcher.  Webmaster
Copyright © 1999 CycleWareables. All rights reserved.
Revised: July 28, 2008