RKA Fax Order Page

RKA Fax Order Form 707 836 1938

SHIP TO:		RKA 930 Shiloh Rd Bldg 41-C Windsor, CA 95492 (USA) 1-800-349-1752 voice 1-707-836-7659 voice 1-707-836-1938 fax
Name ___________________________ Address__________________________ ________________________________ ________________________________ Day Phone ________________________ Eve Phone ________________________ Fax No __________________________ E-Mail ___________________________ IMPORTANT: Motorcycle Description: Brand _____________Model _____________ Yr_______ Color ________ Seat _________

Part #	Description	Qty	Price	Total

Credit Card Information Name on Credit Card: ___________________ __ Visa __ MC __ Disc _____-_____-_____-_____ Exp Date _________ We do not accept "American Express".	Subtotal
	Sales Tax 7.50% (Calif only)
	Shipping Cost (Veries)
	Total
The issuer of the card identified on this item is authorized to pay the amount shown as TOTAL. I promise to pay such TOTAL. Together with any other charges due thereon subject to and in accordance with applicable law and the agreement governing the user of such card.



E-Mail :_____________________________________________
Shipping Terms depend on size and weight

Signature X ___________________________________ Date: __________
Please Fax this order form to RKA at 707 836 1938

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