P-SM820 PATROL CYCLE SHOE ODER FORM

BILLING CONTACT INFORMATION
Name
Address
City
State
Zip
Telephone
Fax
Email
SHIPPING ADDRESS (IF DIFFERENT FROM BILLING)
Name
Address
City
State
Zip
Telephone
SIZE CHART

ORDER DETAILS
EURO SIZE QUANTITY TOTAL
$89.95 PR
SUB TOTAL
IPMBA OR LEBA Membership Number for discount $10.00/PR
Delivery and Handling Charge 1 Pr. $9.90, 2 PRS $14.90, 3 Prs & Up $6.00/Pr
DISCOUNT AMOUNT  
DELIVERY CHARGE  
TOTAL AMOUNT  
PAYMENT AUTHORIZATION

Visa   Mastercard
Card Number
Exp.Date /
Security Number
All orders will be placed offline and verified before shipping. Please refer to our Terms of our Warranty and Returns & Exchanges, and if you have any questions or require further information about the shoes, their sizing, or shipping, please call Patrol Bike Sytems at 1-800-208-2032 during business hours or leave a message at other times.