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ORDER FORM

ITEM #1 MODEL NUMBER QUANTITY PRICE

ITEM #2 MODEL NUMBER QUANTITY PRICE

ITEM #3 MODEL NUMBER QUANTITY PRICE

ITEM #4 MODEL NUMBER QUANTITY PRICE

ITEM #5 MODEL NUMBER QUANTITY PRICE

for volume pricing call us at 1-712-439-3301

SPECIAL FENDER WIDTH REQUIRED FOR MODEL NUMBER WIDTH REQUIRED IN INCHES ADD $29.00 TO COST

SPECAIL FENDER WIDTH REQUIRED FOR MODEL NUMBER WIDTH REQUIRED IN INCHES ADD $29.00 TO COST

all measurements should be outside measurments.

THIS IS FOR FENDERS UP TO 9 INCES WIDE, FOR WIDER FENDERS CALL YOUR ORDER IN TO 1-712-439-3301

FREIGHT RATES for tanks, fenders, nacelles, bag extenders-> 1 UNIT $21.50 --> 2 UNITS $31.50 --> 3 UNITS $ 49.50
--> 4 UNITS $59.50 $
FREIGHT RATES FOR SADDLE BAGS OR TOUR PAKS --> 1 SET -->$49.00
2 SETS-->$89.00 $
these freight rates are for inside the 48 states, for freight rates for anywhere else please e-mail me at oldinc@rconnect.com we ship world wide.

ORDER TOTAL WITH FREIGHT $

PAYMENT

SHIP TO ADDRESS

SHIP TO NAME FIRST & LAST
BUSINESS NAME if applicable
SHIP TO STREET ADDRESS
SHIP TO CITYSTATE ZIP / POSTAL CODE COUNTRY
SHIP TO PHONE NUMBER
E-MAIL ADDRESS


PAY VIA CREDIT CARD
CREDIT CARD HOLDERS FIRST AND LAST NAME
CREDIT CARDHOLDERS BILL TO ADDRESS
CREDIT CARD HOLDERS CITY CREDIT CARD STATE
CREDIT CARDHOLDERS ZIP / POSTAL CODE CREDIT CARD COUNTRY
CREDIT CARD HOLDERS PHONE NUMBER
VISA DISCOVER MASTER CARD
CARD NUMBER
EXP. DATE -MONTH EXP. DATE YEAR 3 DIGIT CODE ON REAR OF CARD


PAY VIA PAYPAL E-mail address you use for your PAYPAL account
A Paypal Invioce will be E-Mailed to you the next business day.

MAIL IN ORDER MAIL ORDERS TO OLDY'S - P.O. BOX 222 - HULL, IOWA 51239 - U.S.A.

PHONE IN ORDER ORDER AT 1-712-439-3301


COMMENTS OR QUESTIONS

HOME REQUEST INFO PLACE ORDER CONTACT US ABOUT US CUSTOMERS BIKES

OLDY'S CUSTOM COMPOSITES - 811 BLACK FORREST ROAD - P.O. BOX 630 - HULL, IOWA - U.S.A. 51239
phone 1-712-439-3301 fax 1-712-439-1249 e-mail golden@rconnect.com