bikeparts.com - Mail and Fax Order Form

bikeparts.com FAX/MAIL ORDER FORM
Please print this form and either:

mail to: Bikeparts.com, Inc. Ordering Dept., 1224 Washington Ave Suite 145, Golden, CO 80401 (include either a money order, cashiers check or your credit card information)
fax to: 1(303)215-0156 (include your credit card information)

Customer Information:

NAME:		HOME PHONE:
COMPANY:		WORK PHONE:
ADDRESS:		FAX:
CITY:		E-MAIL:
STATE/PROVINCE:	ZIP/POSTAL-CODE:	COUNTRY:

Credit Card Information:

VISA/MASTERCARD/DISCOVER (circle one)	ISSUING BANK:
CREDIT CARD #:	EXP.DATE: 3 Digit CCV#:
NAME AS IT APPEARS ON CARD:	AUTHORIZED SIGNATURE:

Products:

Qty.:	Product Name:	Product I.D. #:	Color:	Size (if applicable):	Price:

SUBTOTAL ($) ____________
JEFFERSON CTY, COLORADO RESIDENTS ADD 4.2% SALES TAX ____________
COLORADO RESIDENTS ADD 3% SALES TAX ____________
No Tax on Orders Shipped outside of Colorado

Shipping Method:Domestic Insured Rates (Circle One)

Order Amount	UPS Grnd	UPS 2nd Bus. Day	UPS Next Bus. Day	Military(APO/FPO)
Parts $0-50	6.00	11.00	15.00	10.00
Parts $50+	9.00	14.00	18.00	15.00
Wheels	20.00	40.00	60.00	15.00
Suspension Forks/Rims	12.00	15.00	20.00	20.00

Subtotal:	$_________
Taxes (if applicable):	$_________
Shipping:	$_________
Grand Total:	$_________