Name ___________________________________________ | |
Street ___________________________________________ | |
City ___________________ | State ___________________ |
Zip ____________________ | Country _________________ |
Telephone________________________________________ | |
E-mail___________________________________________ |
QTY | DESCRIPTION | AMOUNT |
_____ | Fixed Seat Model | $6,000.00 |
_____ | Fixed Seat/Sliding Seat Ready | $6,300.00 |
_____ | Fixed Seat/with Trolling Fittings | $6,300.00 |
Sales Tax (if applicable) | ________ | |
Total | ________ |
SPECIFY PAYMENT METHOD: Money Order:___ Check:___ (Make check/money order payable to Middle Path Boats) MasterCard:___ VISA:___ Discover/Novus:___ American Express:___ Credit card orders may also be placed over the phone | |
Account Number: | |
Expiration Date: | |
Signature: _________________________________________ |
I the UNDERSIGNED acknowledge and understand fully the above written information and that the
accompanying deposit for the purchase of a boat is non-refundable subject to the conditions stated above:
Signature: _______________________________________Date:_______
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