LVS Sales, Inc.
Golf Car Parts and Price List Order Form

Please provide the following information:

		GENERAL INFORMATION
	First Name
	Last Name
	Business Name
	Street address
	Address (cont.)
	City
	State/Province
	Zip/Postal code
	Country
	Phone
	FAX
	E-mail

	Method of Payment:	Select One Master Card ($ 10.00) Visa ($ 10.00) Includes Shipping and Handling
	Name on Credit Card:
	Credit Card Number:	*Please provide your V-Code Number as well. This is the 3 or 4 digit number located on the rear or possibly the front of your card
	Expiration Date:
		Or Send $8.00 to: LVS Sales, Inc. 7281 NW 77 Street Miami, FL 33166 This $8.00 charge is fully refundable upon your first purchase order of $75 or more.