PLACE AN ORDER BY PHONE, MAIL, or FAX PHONE PHONE NUMBER 763-478-3698 MAIL The Door-Kart Company 720 Tower Drive Medina, MN 55340 Complete this form. Print and mail it toThe Door-Kart Company. FAX FAX NUMBER 763-478-2052 Complete this form. Print and fax it to The Door-Kart Company. DOOR-KART ORDER FORM SUBMIT TO: The Door-Kart Company, 720 Tower Drive, Medina, MN 55340 BILLING TO: Full Name: Phone: Company Name: Fax: Street: Email: City, State, Zip: How did you hear about Door-Kart: SHIPPING TO: Full Name: Company Name: Street: City, State, Zip: PAYMENT METHOD: Credit Card Type: VISA MC Payment by Cashier Check/Money Order: Payable to: The Door-Kart Company Name on Credit Card: Credit Card Number: Expiration Date: Your Signature: Quantity Item Price Total* DOOR-KART $90.00** *Plus sales tax where applicable and $10 per item for shipping and handling **Normal shipping time 10 days from placed order date

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