Cutom Imprint Kickstand pads and plates
Art Order Form
ORDER FORM
Artwork Specifications
NEW! ONLINE ORDERING NOW AVAILABLE
motorcycle coasters kickstand pads kickstand plates pucks Berlekamp Artistic Solids power sports
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All Information Required to be
Processed for Production!
SHIP TO INFORMATION
Company:
Address:
City, State, Zip:
Phone # (w/AC):
Contact Person:
Date of Order:		 _________________________________________________
_________________________________________________
_________________________________________________
______________________ Fax #:_____________________
_________________________________________________
__________________ Email Address:_________________
Price Chart
Enter Quantities of Combinations Desired
Plastic Color Black   Red   Orange  Lime   Pink  Yellow  Blue  Purple  TOTAL 
White Ink   + + + + + + + =
Black Ink   + + + + = +
Silver Ink   + + + + + + + = +
Gold Ink   + + + + + + + = +
Add $35.00 each ink color change. Total Quantity Ordered =
PAYMENT METHOD
Check # _____________
Credit Card # _______________________________ Expiration Date: ____/_____
V-Code__________* Check Type _____ American Express   _____ VISA
*(The V-Code is the last three- or four-digit number located on the back of your credit card on the signature panel.) of Card _____ Discover   _____  Master Card
Authorized Signature:________________________________________    
BILL TO INFORMATION
Name on Credit Card:
CC Statement Address:
City, State, Zip:
 _________________________________________________
_________________________________________________
_________________________________________________
MAIL or FAX to:
Your One-stop Source for All Styles of Kickstand Pads and Supports
Distributors of Advertising Specialties
Specifically For The Powersports Industry
515 S. Tanner St., Rantoul, Il 61866
1-800-CROWN-IT (276-9648) • Fax: 888-704-4687
E-mail: sales@crownadv.com

Rev. 01/22/2010 - CA