Trikke Chicago Purchase Order Form

Trikke Chicago - Merchandise Order Form
Date of Order

Month Day Year
Full Name *

First Name Last Name
Phone Number *

Area Code Phone Number
E-mail Address *
Confirm E-mail Address *
Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Shipping Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
*

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: *
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T5 Jogo $ 130.00

Quantity Color

T67 $ 260.00

Quantity Color

T7 $ 220.00

Quantity Color

T78CS $ 300.00

Quantity Color

T78 Deluxe $ 430.00

Quantity Color

T8 Sport $ 800.00

Quantity Color

Trikke Colt $ 600.00

Quantity Color

Trikke Freedom $ 1,100.00

Quantity Color

36V Electric Fitness $ 1,700.00

Quantity Color

48V Electric $ 2,400.00

Quantity Color

48V Electric Patrol $ 3,790.00

Quantity Color
Credit Card Details
Full Name *
*

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

Trikke Chicago - Merchandise Order Form