WORK ORDER

Sold To:

Name:

Address:

City:

State:

Zip:

Telephone:

Ship To:

Name:

Address:

City:

State:

Zip:

Telephone:

Bike Description:

Model:

Brand/Type

Color:

Description:

Tank (square or oval)

Flames (yes/no)

Inserts:

Other:

Accessories:

Saddlebags (yes/no):

Grips (long or short):

Rims:
(Spoke; 2-Spoke Mag; 3-Spoke Mag; Star; Solid)

Carb:

Other Parts:

Personalize:

Comments:

Fenders:

Choose Fender Style (#1, #2, or #3):

Send Pictures and/or Order by Mail to the Address Below:

EASYROCKERS
P.O. BOX 1313
BRENTWOOD, CA 94513
(925) 634-5720 WE THANK YOU FOR YOUR INTEREST & CONTINUED BUSINESS WITH EASYROCKERS M.C. U.S.A.