Circle City Bicycles Order Form

Circle City Bicycles Order Form

Circle City Bicycles Order Form

Name: __________________________________________________

Address: ________________________________________________

________________________________________________________

Phone (eve): _ (day):___

E-mail: ____________________________________________________

Item # (if any), Description & Price

_ ________________________ $_

_ ________________________ $_

_ ________________________ $_

_ ________________________ $_

_ ________________________ $_

_ ________________________ $_

_ ________________________ $_

TOTAL PRICE OF ALL ITEMS................................... $_________

Indiana residents add 6% sales tax............................... $_________

SHIPPING ...................................................................... $_________

TOTAL .......................................................................... $_________

Make check payable to "Circle City Bicycles" and mail this form (or fax to 317-784-7684) to:
Circle City Bicycles
5506 Madison Ave.
Indianapolis, IN 46227

Card #: Exp: _ - _ Billing ____________________________
Visa Mastercard American Express Discover