MYTIGHTRIDE.COM ORDER FORM

(714) 956-3801 PHONE

(Please print this form from your browser)

MYTIGHTRIDE                                                                                                                                        Date:  _____________________

2211 E. WINSTON, SUITE K

ANAHEIM, CALIFORNIA 92806-5539

(714) 956-3801 - FAX

BUYER:  (This information MUST be the same as the billing information on your credit card, unless paying by check)

Name

Address

City State ZIP

Email

Telephone

ORDER:

Item #	Item Description	Qty.	Price	Extended
			Tax (7-3/4%) (California Only)
			Shipping (no tax on shipping)
			Total

VEHICLE DESCRIPTION:  (Note:  please indicate any unique factory features about your vehicle that would apply to the products you ordered.  Such as Extra Cab, Fog Lights, Wing, etc.

Year	2/3/4 Door
Make (Honda)	Other Description
Model (Accord)	Other Description

PAYMENT INFORMATION:

VISA	MASTERCARD	AMERICAN EXPRESS	DISCOVER	CHECK/MONEY ORDER/CASHIER’S CHECK (Make Payable to Mytightride)
CARD NUMBER
EXP. DATE			CVV Number 3 digit number on back of card

______________________________________________    ________________________

Signature of Cardholder (must match name above)   Date

If paying by credit card, Mytightride will NOT ship to an address that is different on the BUYER’S credit card.  I authorize Mytightride to charge the credit card number indicated above for the total above plus shipping charges and sales tax (if applicable). I certify that the credit card number and my signature hereto match the BUYER information above and on my credit card statement.  As such, I am an authorized signer on this card.