| SHIP TO: | NAME:________________________________________________________ |
| ADDRESS:_____________________________________________________ | |
| CITY/STATE/ZIP:_______________________________________________ | |
| E-MAIL ADDRESS:_______________________________________________ | |
| PHONE NUMBER:________________________________________________ | |
| FULL DESCRIPTION | | | QTY | | | EXT. PRICE | | | PRICE |
| _________________________________________ | | | _______ | | | _______ | | | _______ |
| _________________________________________ | | | _______ | | | _______ | | | _______ |
| _________________________________________ | | | _______ | | | _______ | | | _______ |
| _________________________________________ | | | _______ | | | _______ | | | _______ |
| _________________________________________ | | | _______ | | | _______ | | | _______ |
| _________________________________________ | | | _______ | | | _______ | | | _______ |
| _________________________________________ | | | _______ | | | _______ | | | _______ |
| _________________________________________ | | | _______ | | | _______ | | | _______ |
| SUB TOTAL | _______ | |||||
| AZ. RESIDENT ADD 7.1% TAX | _______ | |||||
| SHIPPING | _______ | |||||
| TOTAL | _______ | |||||
| Payment Information: | MasterCard | Visa | Amex | Discover | Money Order | Cashiers Check |
| Card # ________________________________________________________ Exp. Date _________ | |
| Name on Card ___________________________________________________________________ | |
SIDEWALK
SURFER | 2602 N. Scottsdale Rd. |
Scottsdale, AZ. 85257
Phone: 480.994.1017 | Fax:
480.994.3299 | Email: admin@sidewalksurfer.com