![[mopeds derbi predator mopeds derbi predator moped parts derbi predator scooter parts derbi predator mopeds scooters moped world email]](MopedWorldHeaderLogo.gif)
| 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 .: . .
|
|
|