Method of Payment
METHOD OF PAYMENT
Check/Money Order enclosed (Payable to: KidCo, Inc.)
VISA (13 or 16 digits)
Credit card account number
Signature of cardholder
Please print name of cardholder
Name
Street address
City
1013 Technology Way
Libertyville, IL 60048-5349
16
Please do not send cash.
Mastercard (16 Digits)
Mo.
Expiration date (required)
State
SHIPPING AND HANDLING CHARGES
If order includes extension tubes, bars or
spindles add $8.00
All others add $5.00
Order amount
Shipping & handling
Total
Yr.
Date
Day time phone no.
Unit
Zip
$
$
$