Fax Order form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=125 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <IMG SRC="057066c0.png" border=0 width="518" height="108" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> </div> </td> </tr><tr> <td valign="top" height=355 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#0000FF" FACE="Arial Rounded MT Bold" ><I><B>Motorcycle Paint Supply </B></I></FONT>     |     <A HREF="index.htm" TARGET="_top" TITLE="Motorcycle Paint Supply "><U>Home</U></A></div> <div> <A HREF="id50.html" TARGET="_top" TITLE="Kolor 5"><U>Kolor 5</U></A>   |   <A HREF="id52.html" TARGET="_top" TITLE="Kolor 4"><U>Kolor 4</U></A>   |   <A HREF="id53.html" TARGET="_top" TITLE="Kolor 3"><U>Kolor 3</U></A>   |   <A HREF="id54.html" TARGET="_top" TITLE="Kolor 1"><U>Kolor 1</U></A>   |   <A HREF="id55.html" TARGET="_top" TITLE="Kolor 2"><U>Kolor 2</U></A>   |   <A HREF="id57.html" TARGET="_top" TITLE="ReFillable Aerosol can "><U>Re-Fillable Aerosol can </U></A>   |   <A HREF="id66.html" TARGET="_top" TITLE="EPI Products"><U>EPI Products</U></A>   |   <A HREF="banner.html" TARGET="_top" TITLE="Banner"><U>Banner</U></A>   |   <A HREF="id71.html" TARGET="_top" TITLE="California Duster"><U>California Duster</U></A>   |   <A HREF="id72.html" TARGET="_top" TITLE="EZ Dabber"><U>EZ Dabber</U></A>   |   <A HREF="id73.html" TARGET="_top" TITLE="MSDS TECH"><U>MSDS & TECH</U></A>   |   <A HREF="id75.html" TARGET="_top" TITLE="Chip Example"><U>Chip Example</U></A>   |   <A HREF="how_to_paint_a_motorcyle.html" TARGET="_top" TITLE="How to Paint a Motorcycle"><U>How to Paint a Motorcycle</U></A>   |   <A HREF="id79.html" TARGET="_top" TITLE="eBay "><U>eBay </U></A>   |   <A HREF="id81.html" TARGET="_top" TITLE="Painter Wanted!"><U>Painter Wanted!</U></A>   |   <A HREF="id82.html" TARGET="_top" TITLE="Paint work"><U>Paint work</U></A>   |   <A HREF="id84.html" TARGET="_top" TITLE="Cheap Tricks!"><U>Cheap Tricks!</U></A>   |   <A HREF="id87.html" TARGET="_top" TITLE="Search: cyclecolor.com"><U>Search: cyclecolor.com</U></A>   |   <A HREF="auto_paint_and_touch_up_color_information.html" TARGET="_top" TITLE="Automobile Paint Code locations"><U>Automobile Paint Code locations</U></A>   |   <B>Fax Order form</B>   |   <A HREF="id91.html" TARGET="_top" TITLE="What our Customers say!"><U>What our Customers say!</U></A></div> <div> Fax Order form<FONT SIZE="2" COLOR="#0000FF" FACE="Arial" >  </FONT><FONT SIZE="2" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="601" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 613 WIDTH="589"><div> <B>Credit card fax authorization: </B><FONT SIZE="2" COLOR="#000000" FACE="Arial" >I the undersigned, authorize "Z - Performance" to charge my credit card for Payment for Products or Services according to the information shown below.</FONT></div> <DIV ALIGN="LEFT"></DIV> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="582" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 107 WIDTH="255"><div> TYPE OF PURCHASE </div> </tD> <tD VALIGN=TOP><NOBR><div> o<FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > Motorcycle Carrier</FONT></div> <div> o<FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > Paint</FONT></div> <div> o<FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > Touch up paint</FONT></div> <div> o<FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > Information or Publications</FONT></div> <div> o<FONT SIZE="2" COLOR="#000000" FACE="Wingdings" > </FONT><FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" >Note: _____________________________________ </FONT></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 134 WIDTH="255"><div> TYPE OF CARD </div> <bR> <bR> <bR> <div> * 4 digit Series # on front of American Exp. Card</div> <div> * 3 digit Card Verification number - back of card<FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > </FONT></div> </tD> <tD VALIGN=TOP><NOBR><div> o<FONT SIZE="2" COLOR="#000000" FACE="Wingdings" > </FONT><FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" >VISA</FONT></div> <div> o<FONT SIZE="2" COLOR="#000000" FACE="Wingdings" > </FONT><FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" >AMERICAN EXPRESS</FONT></div> <div> o<FONT SIZE="2" COLOR="#000000" FACE="Wingdings" > </FONT><FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" >MasterCard</FONT></div> <div> o<FONT SIZE="2" COLOR="#000000" FACE="Wingdings" > </FONT><FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" >Discover </FONT></div> <div> * Card Verification # ____________________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 62 WIDTH="255"><div> NAME ON CARD (Print)</div> <div> Address</div> <div> Town, State & Zip code <FONT SIZE="2" COLOR="#000000" FACE="Arial" > </FONT> </div> </tD> <tD VALIGN=TOP WIDTH="312"><div>  <FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 16 WIDTH="255"><div> CREDIT CARD NUMBER </div> </tD> <tD VALIGN=TOP WIDTH="312"><div>  <FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 16 WIDTH="255"><div> EXPIRATION DATE <FONT SIZE="2" COLOR="#000000" FACE="Arial" > </FONT> </div> </tD> <tD VALIGN=TOP WIDTH="312"><div>  <FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 39 WIDTH="255"><div> AUTHORIZED AMOUNT </div> <div>  <FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > </FONT></div> </tD> <tD VALIGN=TOP><NOBR><div>   </div> <div> o<FONT SIZE="2" COLOR="#000000" FACE="Wingdings" > </FONT><FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" >US Dollars only!   $ _______________________</FONT></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 16 WIDTH="255"><div> DATE <FONT SIZE="2" COLOR="#000000" FACE="Arial" > </FONT> </div> </tD> <tD VALIGN=TOP WIDTH="312"><div>  <FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 42 ><NOBR><div> SIGNATURE </div> <div> <B>e-mail address to confirm Order: </B><FONT SIZE="3" COLOR="#000000" FACE="Arial Rounded MT Bold" ><B> </B></FONT></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="312"><div>  <FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" > </FONT></div> </tD> </tR> </TABLE></div> <div>   <FONT SIZE="2" COLOR="#000000" FACE="Arial Rounded MT Bold" >AFTER COMPLETING THE FORM PLEASE PRINT IT, </FONT></div> <div> SIGN IT AND FAX TO US AT ( 708 ) 479-0099</div> <div> We will confirm your order by Your fax#: ________________</div> <div> or email_____________________</div> </tD> </tR> </TABLE></div> <div>  </div> <DIV ALIGN="LEFT"></DIV> <div>  </div> <bR> </td> </tr></table></body>