Fax Order Form 707 836 1938
930 Shiloh Rd
Bldg 41-C
Windsor, CA 95492
1-800-349-1752 voice
1-707-836-7659 voice
1-707-836-1938 fax
 Name ___________________________
Day Phone ________________________
Eve Phone ________________________
Fax No __________________________
E-Mail ___________________________

Motorcycle Description:
Brand _____________Model _____________
Yr_______ Color ________ Seat _________
 Part #
Credit Card Information
Name on Credit Card: ___________________
Visa __ MC __ Disc _____-_____-_____-_____
Exp Date _________
We do not accept "American Express".
 Sales Tax 7.50% (Calif only)  
 Shipping Cost (Veries)  
 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:
If in the Continental 48 United States Shipping ground UPS is $8.00 no matter how much is ordered. Puerto Rico, Hawaii, and other countries shipping will differ from amount ordered to destination shipped when using 3 day, 2 day, next day UPS & USPS. We will also fax you back, or e-mail you your total amount and a set ship date.

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

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