Wheelchairs on the Go

Order Wheelchairs on the Go: Accessible Fun in Florida
Prices, shipping & sales tax info

ORDER BY MAIL: Fill out the form below, print and mail with payment to:
Wheelchairs on the Go
14074 Egret Lane, Clearwater, FL 33762

Name

Street Address

City

State/Province Zip/Postal Code Country

Phone# E-mail address

Card Number Exp. Date
Name on Card

Where did you hear about us?

Signature _____________________________________________________

Select One:

Check

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Mastercard Send me book(s) @ $24.95 (US funds) each= $
Shipping/Handling space
Out of Florida - $3.00/book = $
(No charge to Florida addresses) = _________

Overseas add $10.00/book = $

Sales Tax for Florida addresses $1.75/book = $

TOTAL = $

Name
Street Address
City
State/Province	Zip/Postal Code Country
Phone#	E-mail address
Card Number	Exp. Date
Name on Card
Where did you hear about us?