Performance Fasteners Order Form

Name:

Address:

Phone Number:

E-Mail Address:

Product(s) you wish to purchase and quantity:

Tool Bag Kit	@ $12.95 ea. plus shipping and handling costs
Garage Kit	@ $49.95 ea. plus shipping and handling costs
Shop Kit	@ $69.95 ea. plus shipping and handling costs
Refill Kit (indicate size and quantity)

*North Carolina residents add appropriate sales tax.

Application (ex. streetbike, dirtbike, atv...):

How did you first discover Performance Fasteners?:

Credit Card Type:

Credit Card Number And Expiration Date:

Name As Printed On The Credit Card:

Ship To Address (if different from address given above):

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