Customer Order

Customer Details

Name:

Address:

 

Postcode:

Telephone:

Email:

Order Details

Scooter Make & Model...........................................................................................................................................................................

Quantity:......................

Value:...................

 

Delivery Method: Please select how you would like your scooter delivered

Standard Delivery: add 50

Collection:

 

I enclose a cheque to the value of: £...........................................................................................................

..........................................................................................................................................................(Signature)

...................................................................................................................................................................(Date)

Please Note: You will recieve a confirmation email of your order and will be contacted regarding delivery. Scooters will only be dispatched once the cheque has been cleared.