MAIL-IN ORDER FORM

MAXAMILE L.L.C.

DESIGNED TO MAXIMIZE YOUR MILES PER GALLON - COSTS LESS THAN A FILL UP!

MAIL-IN ORDER FORM

ORDER FORM
MAXAMILE L.L.C.					Date
*Maximize your miles per gallon!*
*Maximize your miles per gallon!*
*Please print this form, complete, and mail with payment to the address below.*

Name			Ship to:
Address			Address

City/State/Zip			City/State/Zip
Phone No.

Qty	Item #	Description			Unit Price	Line Total
	1206	Maxamile Gas Pedal Regulator			$ 49.99








		If shipped to NC please add tax (6.75%)			6.75%
		If shipped to NC please add tax (6.75%)				-0-

		BY PLACING THIS ORDER, I ACKNOWLEDGE THAT I UNDERSTAND THE RETURN POLICY.
				Total Due		$

For faster order processing it is recommended that you pay with a money order.

If paying by check please allow extra time for processing.

Make payable to: MAXAMILE L.L.C.
and mail to: 5184 Reidsville Rd - Suite 100-#119, Walkertown, NC 27051

*Thank you for your order*

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