Lo-Fi Customs Mail Order Form

Name: ________________________ Phone: ________________________
Address: ___________________________________________________
City: ________________________ State/Province: ________________________
Postal Code: ________________________ Country: ________________________
Email: ___________________________________________________

PRODUCT NUMBER QTY DESCRIPTION SIZE PRICE PER UNIT SHIPPING TOTAL $
03-menblack-ss 1  EXAMPLE: War Bike M $  15.00 $  3.50 $  18.50
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
__________ ___ __________________________ ___ $______ $______ $______
Send this completed form along with your check or money order to:
(Make checks and money orders payable to "Lo-Fi Customs" )

Lo-Fi Customs
1421 Lawton ST
Harrisburg, PA 17102
USA

TOTAL ORDER
$

Questions/Comments: