| Customer Information: | |||
| Name: | Address: | ||
| City | State: | Zip: | |
| Height: | Weight: | Skill Level: | |
| Type of riding you do: | Type of terrain: | ||
| Home Phone: | Work Phone: | ||
| Cell phone: | Pager: | ||
| Email address: | |||
Address
you will have the Bike shipped: |
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| Name: | Attn: | Address: | |
| City: | State: | Zip: | |
| Phone: | |||
*Bikes
will be shipped in order of receipt of deposit. |
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Service
Honda SRX250R Ordering Instructions 1) Fill out
the order form including description and price and return it to us or
call us at (219) 932-3588. |
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| Description |
Price |
| One 2004 Service Honda SRX250R Kit | $4999 |
| Shipping | |
Total |
|
Deposit
(required) $1000 |
|
Balance
(due prior to shipping) |