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MOPED WORLDŽ
Copyright Š Moped WorldŽ
MOPED WORLDŽ
MOPED WORLDŽ
P.O. Box 27034
Greenville, SC 29616 USA
Name:_____________________________________

Shipping Address:____________________________

__________________________________________

City:______________________________________

State:__________________    Zip:______________

Daytime Phone #: (______)_______-_____________

Home Phone #: (______)________-______________


Orders must be pre-paid via Money Order, Cashiers Check or Personal Check. Make checks payable to: Moped WorldŽ. For Personal checks, shipping address above must be "on file" at your bank. All information is kept confidential. ALL checks must clear before shipment. We check the validity of ALL checks. Remember to write down your bank's telephone number and sign this form before mailing it in.
_________________________________________
Cell Phone Number (optional)

_________________________________________
Pager Phone Number (optional)

_________________________________________
How did you hear about us?

_________________________________________
Your Bank's Telephone Number (w/area code)

_________________________________________
Your Signature

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