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Fax Order form  
Credit card fax authorization: I the undersigned, authorize "Z - Performance" to charge my credit card for Payment for Products or Services according to the information shown below.
TYPE OF PURCHASE
o Motorcycle Carrier
o Paint
o Touch up paint
o Information or Publications
o Note: _____________________________________
TYPE OF CARD



* 4 digit Series # on front of American Exp. Card
* 3 digit Card Verification number - back of card
o VISA
o AMERICAN EXPRESS
o MasterCard
o Discover
* Card Verification # ____________________
NAME ON CARD (Print)
Address
Town, State & Zip code
CREDIT CARD NUMBER
EXPIRATION DATE
AUTHORIZED AMOUNT
o US Dollars only!   $ _______________________
DATE
SIGNATURE
e-mail address to confirm Order:
  AFTER COMPLETING THE FORM PLEASE PRINT IT,
SIGN IT AND FAX TO US AT ( 708 ) 479-0099
We will confirm your order by Your fax#: ________________
or email_____________________