Planet One CyclesTM Product Order Form

Please print this form, and then fill in all information below.

Please send this form and payment to:

Planet One Cycles
P.O. Box 286
East Lyme, CT, 06333
USA

U.S. Orders:
Make checks payable to Planet One Cycles. Thank you for your business!

Foreign Orders must pay by Postal Money Order in U.S. Dollars.
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					  Date:______/_____, 20_____



Name _______________________________________


Address ___________________________________________________


City _____________________________  State _______  ZIP ____________


Country _________________________________________

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Enter the quantity of each item purchased.


Quantity    	Item Description	Cost Each        	Shipping*
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  ____		Power Tamers	   $18		  $3.50    


  ____		Oil Caps		   $32		  $3.50


(CT residents add 6% sales tax)
*Shipping outside the U.S. will be slightly higher. Please 
e-mail us for details.


TOTAL: $_________________

Check No.(if paying by check) ______________________________________
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