Personal Information
First Name_________________________M.I._____Last Name_______________________________
Billing Address______________________________________________________________________
City____________________________________State_____________Zip Code__________________
Daytime Phone(_____)__________________________Evening Phone(_____)____________________
E-Mail Address________________@______________________Fax No.(_____)________________
Name as shown on credit card_________________________________________________________
Credit Card Number________________________________________Exp. Date_________________
Shipping Address (If different than billing address)
Company Name If Applicable_________________________________________________________
Ship To Name_____________________________________________________________________
Shipping Address___________________________________________________________________
City___________________________________State_____________Zip Code__________________
Item(s) Ordered Price
___________________________________________ ___________________
___________________________________________ ___________________
___________________________________________ ___________________
Sales Taxes_For Residents of California (7.25%)
___________________
Shipping (See our note regarding shipping or call us)
___________________
Total Amount To Be Paid (Charged To Card)
___________________
Your Signature__________________________________________Date_____________________
Our Fax 661-832-5277, Our Phone 661-832-5270
E-Mail Us At
Sales@Motorcycle-Luggage.com
Mail Us At 6801 White Lane, Suite H-4, Bakersfield, California 93309
Call Us For Questions and Thank You Very Much For The Business