Mean City Cycles - Print Order Form

Ship To:

Mean City Cycles
525 E. Main Street
Maiden
NC
28650
1 (866) 550-SEAT

Return Shipping Address:

Jerry
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MO
56723
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email@email.com

Rider Info:

Rider's Weight (Pounds):
170
Rider's Height (Inches):
1890
Rider's Inseam (Inches):
180

Rider Modification:

Motorcycle:
1987
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Riders Choice

Passenger Info:

Passenger's Weight (Pounds):
81

Passenger Modification:

Passenger seat backrest

Accessories:

Do not add a backrest mod to my order.

Additional Information:

I want to be free as a bird

Payment Method:

visa

Express Service $100 plus cost of modification:

[YES - I want EXPRESS SERVICE
[NO - I do not want EXPRESS SERVICE

Do not forget if you would like to take advantage of our Express Services you will have to call. Express service requires a $50 deposit that is non-refundable.

** Disclaimer **

This is an order form not a bill or guarantee of price - once your seat is received we will call you with the exact amount of your modification. If you prefer to call and get an exact price before sending your seat please do so.

Mean City Cycles require certain security measures to accept payment on your card. To be in compliance we must have this receipt signed as an authorization to process your purchase. We must be able to provide this document if requested by your credit card company, or our credit card processing service. All this information will be kept confidential and stored in a secure location. If you have any questions please call us at (866) 550-SEAT (7328). Thank you for your continued trust and confidence.

I hereby authorize Mean City Cycles to work on my Motor Cycle seat and charge my credit card number I have provided them to cover the charges or my order.

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Signature

Click to Print Your Order Form