Vista Kawasaki                                                    
Order Form


DIRECTIONS:
1. From your browser, print out this form.
2. Fill out the hard copy (please print legibly).
3. FAX the completed form to us at 937-298-9811 (Credit Cards Only)
   or mail it to us at the following address:
Vista Kawasaki
3916 Wilmington Pike
Dayton, OH 45429

4. If mailing a check, make payable to: Vista Kawasaki (US $ only)
5. And, thanks for your order!

BILL TO:

__________________________________________ Name _____________________ E-mail Address

__________________________________________ Address 1

__________________________________________ Address 2

_______________________City ________________State __________ ZIP___________Country

__________________________________________ Phone Number (include area code)

__________________________________________ Business Number (include area code)

__________________________________________ FAX Number (include area code)

__________________________________________ PO Number

____________________________VISA Number ____________________________MC Number _____CCV Number
                                                         (CCV Number is 3 digit # on back of card)
_____/_____ Date of Expiration   _________________________________________Signature


SHIP TO: (only if different than BILL TO above)

__________________________________________ Name

__________________________________________ Address 1

__________________________________________ Address 2

_______________________City ________________State __________ ZIP___________Country

__________________________________________ Phone Number (include area code)

__________________________________________ Business Number (include area code)

__________________________________________ FAX Number (include area code)


MERCHANDISE

Part Number      Description                         Unit 
                                                     Price    Qty.   Total

K_____________   _________________________________   ______   ____   _________

K_____________   _________________________________   ______   ____   _________

K_____________   _________________________________   ______   ____   _________

K_____________   _________________________________   ______   ____   _________

K_____________   _________________________________   ______   ____   _________

K_____________   _________________________________   ______   ____   _________

K_____________   _________________________________   ______   ____   _________

K_____________   _________________________________   ______   ____   _________

K_____________   _________________________________   ______   ____   _________


                                                MERCHANDISE TOTAL: $ _________
      Ohio Only (add if appropriate)
      If purchased in Ohio - 7.5%                       SALES TAX: $ _________

                                                         SUBTOTAL: $ _________


      Within the continental U.S. if SUBTOTAL IS:                          FREIGHT & HANDLING: $ _________
      $5 to $25, then FREIGHT & HANDLING is $4.95
      $26 to $100, then FREIGHT & HANDLING is $6.95
      $101 to $200, then FREIGHT & HANDLING is $8.95
      $201 to $300, then FREIGHT & HANDLING is $10.95
      Greater than $300, then FREIGHT & HANDLING is FREE!

      Above applies to 48 contiguous United States.
      Alaska, Hawaii & International will be posted soon.


                                                            TOTAL: $ _________


                 All prices subject to change without notice.

           If you have any questions, please call us at:

                         1-800-577-1403