Comfort Curves by Gayle
DELUXE SEAT SAVER CUSHION ORDER FORM
For photos, refer to the Motorcycle page when making choices for this form. Call (715)455-1652 for custom color or fabric information.
Motorcycle Driver Seat Saver Cushion Quantity Item Price Total Price
 _______ $49.00 $_________
Top Fabric Choices - Circle or highlight color choice

Faux Sheep 1.Black

Faux Butter Suede 1.Black
Polar Fleece 1. Black Scroll
Motorcycle Passenger (slim) Seat Saver Cushion Quantity Item Price Total Price
 _______ $39.00 $_________
Top Fabric Choices - Circle or highlight color choice

Faux Sheep 1.Black

Faux Butter Suede 1.Black
Polar Fleece 1. Black Scroll
Motorcycle Passenger (fat boy) Seat Saver Cushion Quantity Item Price Total Price
 _______ $39.00 $_________
Top Fabric Choices - Circle or highlight color choice

Faux Sheep 1.Black

Faux Butter Suede 1.Black
Polar Fleece 1. Black Scroll
Special Instructions:
How did you find us?		 Sub Total $_________
Wisconsin Sales Tax (Wisconsin residents only) 5.5% $_________
Shipping up to $60 $5.95 $_________
Shipping $60 to $120 $7.95 $_________
Shipping over $120 Free $_________
Total Amount Due $_________

Credit Card Type (circle one): Visa, MC, AmEx, Disc

Credit Card # __________-__________-__________-__________

Expiration Date__________ Security Code (3 digits on back)__________(or 4 digits on front by signature)______________

Name on Card

 

Name ___________________________________________________Date_________________________

 

Address ______________________________________________________________________________

 

City________________________________________ State ________ Zip Code _________

 
Phone_________________________Email_________________________________________
mail: byGayle
N14397 380th Street
Ridgeland, WI 54763 USA
We will accept your payment with VISA, Master Card, American Express, or Discover by phone or on the WEB, check, money order or credit card by mail. Email:gayle@bygayle.com Phone:1(715)455-1652