item # description                   qty. price ext.amount                                              







                                            TOTAL
NAME
ADDRESS
CITYSTATEZIP
E-MAIL

PLEASE PRINT ORDER FORM AND SEND CHECK OR MONEY ORDER TO-

Go-Kustom
P.O. BOX 77750, Seattle, WA 98177-0750

SHIPPING IS ON US IN THE U.S. FORIEGN ORDERS ADD $2.95($0-$20)/$5.95($20-$40) / $7.95($40-$60) / $10.95($60-$80) / $12.95($80-$100) FOR SHIPPING AND HANDLING.

WASHINGTON STATE ORDERS PLEASE ADD APPROPRIATE SALES TAX.