Mail completed form with payment to:
PROUD BIKER
POB 100
FALKVILLE AL 35622
Proud Biker Mail Order Form
Best printed "to fit" in LANDSCAPE orientation
http://www.proudbiker.com Email: seller@proudbiker.com

Date:____/____/ 20___

Page: ___ of ___

Buyer Name: _______________________
Street: ____________________________
City: _______________ State:___ Zip:_______
Ship to (if different): ______________________
Street: ______________________________
City:_______________ State:___ Zip:_______
Phone: ____ - ____ - ______ Ext. _____
Fax: _____ - _____ - _______
Email: _______________@__________
Buyer address MUST match card billing address.
Credit Card no.: _____-_____-_____-_____
Name on card:_______________________
Expires:___/____ 3-digit code on back:____
ITEM DESCRIPTION (no item number needed, be sure to list sizes) QTY $ EACH $ TOTAL
1 . . . .
2 . . . .
3 . . . .
4 . . . .
5 . . . .
6 . . . .
7 . . . .
8 . . . .
9 . . . .
10 . . . .
. SUBTOTAL $
ONLY Alabama deliveries must include 7% sales tax SALES TAX $
Include $5 for Priority shipping, or
$21 for Flat-Rate Envelope Express, $25 for non-envelope Express, or $35 for heavy package (4lb+) Express
SHIPPING $
Postal Money Orders preferred. Checks held for 10 days.
Allow up to 3 weeks for non-Express delivery. No Express orders by check!
TOTAL $