Bank Name:
Routing umber: (must be 9 digits)
Account number:
Confirm Account number:
Check number: (upper right corner)
ERT-36
Do you want the PowerPackage to get the 750 Watts Power instead of the250 Watts for only $289.50?
Do you want the Extended warranty for only $75.00?
RT-36
Do you want the Extended warranty for only $75.00?
CargoTrike
Do you want the PowerPackage to get the 750 Watts Power instead of the250 Watts for only $289.50?
Do you want the Extended warranty for only $75.00?
ScootMate-DX electric scooter
Do you want the PowerPackage to get the 750 Watts Power instead of the 500 Watts for only $289.50?
Do you want the Extended warranty for only $75.00?
Do you want the seat with the back rest for only $64.50?
Do you want the rear basket for only $74.95?
B&Ptrike (baby & parent tricycle-stroller)
Do you want the Extended warranty for only $75.00?
Do you want the seat with the back rest for only $74.95?
Electric Heater
Do you want the Extended warranty for only $19.50?
II. CHOOSE YOUR MONTHLY PAYMENT & PUT DOWN YOUR DEPOSIT
You will be able to change your payment amount at any time in the future.
Monthly payment (min. $50.00) :
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Information about You as the Purchaser (shipping address may be different if wanted as shown on the next page)
Billing address
First name Last name
Street address City
State ZIP
Telephone with area code email
Shipping address (leave blank if same as the billing address)
First name Last name
Street address City
State ZIP
Telephone with area code email
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Payment information - please fill out this form
Pay by check instantly. Click here why!
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Bank Name: |
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Routing umber: (must be 9 digits) |
Account number: Confirm Account number: |
Check number: (upper right corner) |
(after clicking the Submit button, please wait a few seconds)
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