Mail orders to: Devo Tech, Inc. c/o SoloRacer.com Fax orders to: 330-940-3249 Ship To: (name and address) Residence: ______ or Business: ______ Name: _________________________ Address: _______________________ Address: _______________________ City: ________________________ State:_____ Zip:_______ Phone: _____________________ E-mail: ___________________________ (for order confirmation) Bill To: (if different than above) Name: _________________________ Address: _______________________ Address: _______________________ City: ________________________ State:_____ Zip:_______ Phone: _____________________ NOTE: The billing information entered above must match your card issuing banks records. If your billing address and shipping address are different, we required you to fax us a photocopy of the front/back of the credit card you are using. We also request you contact your credit card issuer to have this alternate shipping address added to your credit card information. List of Items: Item #: Item Name: Qty: Price Each: Total: ________ ______________________ ____ _________ _________ ________ ______________________ ____ _________ _________ ________ ______________________ ____ _________ _________ ________ ______________________ ____ _________ _________ Merchandise Total: $______________ Shipping (see chart here): $______________ In OH Add 6.75% Sales Tax: $______________ TOTAL: $______________ Method of Payment: _____ Certified Bank Check or Money Order (payable to "Devo Tech, Inc.")   _____ Mastercard   _____ Visa   _____ Discover Credit card #: ____________________________     Exp. Date: ________ (mm/yy) CVV#: _________   (3 digit number on back of card near signature) I agree to pay the above total amount according to my card issuer agreement... Signed: ____________________________   Date: __________