Order Form

1. Please provide the following contact information:

                                                                                        

   Sorry, U.S.A orders only!

   Name
   Street Address
   Address (cont.)
   City
   State/Province
   Zip/Postal Code
   Country
   Work Phone
   Home Phone
   E-MAIL (((VERY IMPORTANT!)))

2. Please provide the following product information:

   Model

   Sport$449.00 Liquimatic$499.00 Bigfoot$629.00 X-ped$629.00 Sup-X-ped$749.00 Hover Board$675.00 Go-quad$799.00 Knowped$159.00 SHIPPED

   Color

   Blue Red Yellow Green Orange Black (Must be color available for model)

3. How many do you Want? (Two max for web purchases)   

   

4. Choose one of the following options :

   Visa
   Master card
   Discover                   
   Amex
    

5. Please provide the following ordering information:

6. Type In Name As Appears On Card.

   (Card Checked For Security Purposes) 

   	BILLING
   Credit Card #.
   Expiration Date

   PLEASE TYPE IN THE AMOUNT YOU AUTHORIZE FOR YOUR SALE  IN DOLLARS 
   We Add 8.00% tax California orders!

                                                    READ OUR PRIVACY STATEMENT HERE!

                                                                OR CALL US @661-252-9374