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motorcycle coasters kickstand pads kickstand plates pucks solid artistic custom imprint sidestand support
ORDER FORM
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All Information Required to be
Processed for Production!
SHIP TO INFORMATION
Company:
Address:
City, State, Zip:
Phone # (w/AC):
Contact Person:
Date of Order:		 _________________________________________________
_________________________________________________
_________________________________________________
______________________ Fax #:_____________________
_________________________________________________
__________________ Email Address:_________________
Enter Quantities of Combinations Desired
Plastic Color Black  Lime   Blue  Orange  Pink  Purple   Red   Yellow Natural  TOTAL 
White Ink   + + + + + + +
=
Black Ink
  + + +
+ + + = +
Silver Ink*   + + + + + + + + = +
Gold Ink*   + + + + + + + + = +
Add $35.00 each ink color change. *Additional running charge Total Quantity Ordered =
PAYMENT METHOD
Check # _____________
Credit Card # _______________________________ Expiration Date: ____/_____
V-Code__________* Check Type _____ American Express   _____ VISA
*(The V-Code is the last three- or four-digit number located on the back of your credit card on the signature panel.) of Card _____ Discover   _____  Master Card
Authorized Signature:________________________________________    
BILL TO INFORMATION
Name on Credit Card:
CC Statement Address:
City, State, Zip:
 _________________________________________________
_________________________________________________
_________________________________________________
MAIL or FAX to:
Your source for The Original Motorcycle Coaster™.
Distributors of Advertising Specialties
Specifically For The Powersports Industry
515 S. Tanner St., Rantoul, IL 61866
1-800-CROWN-IT (276-9648) • Fax: 888-704-4687
E-mail: sales@crownadv.com

Rev. 10/25/2011