MOPED PARTS ORDER FORM

PLEASE PRINT A COPY AND MAIL OR FAX TO:

Continental Cycles Inc./ The Moped Junkyard                                      PLEASE CONTACT US VIA E-MAIL FOR PROPER
7203 Coastal Hwy.                                                                        SHIPPING & HANDLING WHEN USING THIS FORM.
Ocean City, Maryland 21842 USA                                                           ---PLEASE DO NOT GUESS AT A TOTAL---
fax 410-524-8797
INFO@THEMOPEDJUNKYARD.COM

Mail Order Parts Form

CUSTOMER INFO

Name:__________________________________________________________

Address:___________________________________________________________________________________________

City:________________________________ State:______________________ Country:____________

Zip:____________ Province(Int Orders)________________

Phone:_______-_______-____________ Fax:_______-_______-___________

E-Mail:____________________________

MOPED INFO PAYMENT INFO

BRAND:___________________________________                             VISA - MC - AMEX - DIS - MONEY ORDER
                                                                                   (NO PERSONAL CHECKS PLEASE- OTHERS HAVE RUINED IT FOR EVERYONE!)
MODEL:___________________________________                             Card Number:

ENGINE TYPE:_____________________________ _______________________________________

YEAR:_____________________________________ EXP:______/______

PLEASE READ-- New handling charge rates--- this is not postage!
1)DOMESTIC ORDERS UNDER ($50 )ARE SUBJECT TO A $5 HANDLING CHARGE.
--(domestic service manual only and T-shirt only orders are not subject to a handling charge)--

2)INTERNATIONAL ORDERS under ($100 )ARE SUBJECT TO A $10 HANDLING CHARGE- No Exceptions.

3)POSTAL CHARGES ARE NOT INCLUDED IN THE HANDLING CHARGE- We ship Priority Mail.
PRIORITY MAIL-Small packages letter size or less under 1 lb.. add $5.25 for priority mail in the 50 US states.
_______ Please E-Mail for Shipping Quote on larger parts orders___________________________________

PART# ___________DESCRIPTION _______________________________________________________________|__PRICE_____

______________________________________________________________________________________________|_____________

_________________________________________________________6% sales tax -(Maryland customers only)____|_____________

____________________________________________________________________________HANDLING________|_____________

_____________________________________________________________ALL ORDERS SHIP PRIORITY MAIL_|varies by weight

________________________________________________________________________________________TOTAL|_____$________

----------------------Please E-mail for Postage quote- NOT INCLUDED in Handling charge-------------------------
PRIORITY MAIL-Small packages lettersize or less under 1 lbs. add $5.45 for priority mail in the 50 US states
Larger items, PLEASE E-mail for postage quote--- INCLUDE YOUR ZIP CODE!!!

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