JPS Motorsports • Speedster Order Form

ROXSTER ORDER FORM

CLICK HERE TO READ ORDER CONFIRMATION

Name:______________________________ Date:___________________

Address:____________________________________________________

City:___________________________ ST:________ Zip:_____________

Phone:_______________________ Fax:__________________________

E-Mail:_____________________________________________________

ROXSTER Kit or Turnkey?____________________________________

Exterior Color:_______________________________________________

Interior Color: Seats:________________ Carpet:____________________

Top Color:__________________________________________________

Special Exterior Notes? _______________________________________

BASE PRICE: $____________________

Options & Modifications:

Description:______________________________ Price: $____________

Total Price of Options: $________________

TOTAL PRICE (Base + Options): $_____________________

Print Name:_________________________________________________

Customer Signature: __________________________________________

Date:____________________

Deposit Received:___________________________________

Date Received:_____________________________________

CLICK HERE TO READ ORDER CONFIRMATION