Scott MX GEAR ORDER FORM Page 1
MX RIDING GEAR
SCOTT USA ORDER FORM: VALID THRU 9/01/04
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 *
CLOTHING
PANTS ITEM
# COLOR
XSML SML MED LRG XLG XXL
QTY
PRICE
TOTAL
ANAHEIM MX PANT
090827 0 BLUE
100.00
RED
100.00
JERSEY
ITEM # COLOR
XSML SML MED LRG XLG XXL
QTY
PRICE TOTAL
ANAHEIM MX SHIRT
090826 0 BLUE/BLACK
40.00
RED/BLACK
40.00
GLOVES
ITEM # COLOR
XSML SML MED LRG XLG XXL
QTY
PRICE TOTAL
ANAHEIM MX GLOVE
090828 0 BLUE
25.00
GRAPHITE
25.00
PIT GLOVE
090836 0 BLACK
21.00
AIR PRO GLOVE
090164 0 BLACK
15.00
PACKAGE DEAL
IF YOU PURCHASE PANTS, JERSEY AND GLOVES
150.00
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
