Trikke Chicago Purchase Order Form

Trikke Chicago - Merchandise Order Form
Date of Order

MonthDayYear
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail Address*
Confirm E-mail Address*
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
*

Please ship my purchase.I want to pick up my purchase.
Order Details

Prices quoted do not include tax and/or shipping. Tax will be applied for IL residents only.
Trikke Model Selection:*
prevnext( X )
T5 Jogo$130.00

QuantityColor

T67$260.00

QuantityColor

T7$220.00

QuantityColor

T78CS$300.00

QuantityColor

T78 Deluxe$430.00

QuantityColor

T8 Sport$800.00

QuantityColor

Trikke Colt$600.00

QuantityColor

Trikke Freedom$1,100.00

QuantityColor

36V Electric Fitness$1,700.00

QuantityColor

48V Electric$2,400.00

QuantityColor

48V Electric Patrol$3,790.00

QuantityColor
Credit Card Details
Full Name*
*

Please charge my credit card for the above order.
Should be Empty:

Trikke Chicago - Merchandise Order Form