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Order a CosyCycleTM
Tel: 403-804-1168 | Fax: 403-280-5610 | E-mail: info@ultimate-quadracycle.com
To order a CosyCycleTM, please follow these easy instructions:
  • For current pricing, options, & other order details, please call us at 403-804-1168 or click here to e-mail us.
  • Print out this page.
  • Fill out the form and FAX it to 403-280-5610.

DELIVER TO:

NAME:
COMPANY NAME:
STREET:
CITY:
PROV./STATE: POSTAL/ZIP CODE:
TELEPHONE:
 
 

ORDER:

Please list the desired CosyCycleTM Model and then any accessories by description (and part number where applicable).

COSYCYCLETM MODEL:

MODEL DESCRIPTION QUAN. UNIT
COST		 AMOUNT
         
         
         

ACCESSORIES:

PART
NUMBER		 DESCRIPTION QUAN. UNIT
COST		 AMOUNT
         
         
         

SHIPMENT:

$80 crating charge - please select one:

 
Freight collect (Pay when delivered)
 
Freight Prepaid (Add delivery charges)
 
Hold for Pickup (Pre-paid orders only)
SUB
TOTAL		  
7%
GST		  
TOTAL  

PAYMENT METHOD:

 
Certified cheque or money order enclosed.
 
VISA
 
MASTERCARD
CARD NUMBER:
EXP. DATE:
NAME ON CARD
AUTHORIZED SIGNATURE

SS# (For Customs Use Only):
Copyright © 2007 Ultimate Quadra-CYCLE Ltd.