GOGGLES ORDER FORM
SCOTT USA ORDER FORM: VALID 09/01/03-09/01/04 MOTO CROSS "PRO PRICE LIST"
P.O. BOX 2030 SUN VALLEY, ID 83353 (208) 622 1000
Name:
Phone:
Shipping address: (no p.o. boxes)
* THIS PROGRAM IS NOT VAILD WITH ANY CONTINGENCY CERTIFICATES *
SCOTT GOGGLES
MODEL
ITEM #
BLK GRH BLU BRG GRN RED CLR GRY SIL
WHT YEL GUN QTY
PRICE TOTAL
ULTIMATE HiVOLTAGE
090796 0
46.00
HiVOLTAGE II
090780 0
28.00
NO SWEAT IV
090779 0
24.00
NO SWEAT IV(ANODIZED)
090779 0
24.00
VOLTAGE "X"
090569 0
21.00
VOLTAGE X OTG
090783 0
27.00
NO SWEAT III(OTG)
090468 0
27.00
MODEL 87 OTG
090206 0
23.00
MODEL 89 W LIGHT SEN LENS
090775 0
22.00
MODEL 89X
090207 0
20.00
VOLTAGE "R"
090211 0
13.00
VOLTAGE "R PRO
090797 0
16.00
SNOWMOBILE SERIES
MODEL
ITEM #
BLK GRH OBU WBU KGR RED CLR
QTY
PRICE TOTAL
High Voltage Snowcross
090791 0
30.00
VOLTAGE X OTG THERMAL
090792 0
30.00
89X TURBOFLOW AMP
090025 09
24.00
87 TURBOFLOW
090385 09
27.00
VOLTAGE "R" THERMAL
090211 07
20.00
SCOTT VISION SYSTEM
MODEL
ITEM #
BLK GRH OBU WBU KGR RED
QTY
PRICE TOTAL
H.V. VOLTAGE II VISION SYSTEM 090784 0
46.00
VOLTAGE "X" VISION SYSTEM
090571 0
33.00
GOGGLE CASE
QTY
PRICE TOTAL
FIVE PIECE GOGGLE CASE
BLK
15.00
STICKERS
EACH RIDER CAN ORDER 1 STICKER SHEET AND 2 DIE CUTS AT NO CHARGE
MODEL
ITEM #
QTY PRICE
TOTAL
36" DIECUT STICKER , BLK OR WHT
090470 0
N/C
18" TRAILER DIECUT, BLK OR WHT
090195 0
N/C
STICKER SHEET
090196 0
N/C
PAYMENT ACCEPTED IN THE FORM OF A CHECK, MONEY ORDER, OR MASTERCARD/VISA
TOTAL AMOUNT ON ORDER FORM
$
SHIPPING AND HANDLING
8.00
TOTAL AMOUNT DUE
Credit card information:
Authorized CC Holders Name:
(Print)
(Signature)
(CIRCLE ONE)
Mastercard/ Visa /American Express
CC EXP. DATE
