Premium Foam Conversion Order
Form - Instructions
Use PRINT and COMPLETE this form when sending your BMW OEM seat to Sargent for a premium
foam conversion product installation.
1. Fill out section [A] of the order
form. No Post Office Boxes Please! We can only return your seat to a street address.
DAYTIME phone number is critical if we have questions.
2. Complete your order details in section [B]. IF YOU HAVE ALREADY SECURED
YOUR ORDER BY PHONE or E-COMMERCE - please skip step 3 and section [C].
3. NEW ORDERS ONLY - Complete the Method of Payment in section
[C]. If you have already secured your order with a credit card by phone or
e-commerce, then you may skip this step.
4. Attach the order form and any
special instructions to the seat. Box up the seat and ship to:
Sargent Cycle Products, 1036 Hubbard Street, Jacksonville, FL 32206.
NOTE: It should be inexpensive to ship
your seat by ground transportation, especially if you box it yourself and take it to a
U.P.S. or U.S. Post Office outlet. Packing and shipping companies are more convenient, but
charge accordingly.
Section [A]
[ ] New Order |
[ ] Phone Order
Order Date:_________ |
[ ] E-Commerce
Order #: ____________ |
Return Seat To: |
NAME:
(FIRST, MI, LAST) |
|
COMPANY
NAME:
(IF APPLICABLE) |
|
| APT
or SUITE #:: |
|
| STREET
ADDRESS: |
|
| CITY,
ST, ZIP |
|
| DAYTIME
PHONE: |
|
EMAIL
ADDRESS:
We will email return UPS
shipping confirmation, if desired. |
|
| Premium
Foam Conversion for the 2001+ F650GS / F650GS Dakar |
| Premium
Foam Conversion for the 2009+ G650GS |
| Year: |
|
| Colors: |
|
PLEASE DON’T
FORGET TO ATTACH THIS ORDER FORM TO THE SEAT!
1036 Hubbard Street
Jacksonville, FL 32206 • 1-800-749-7328 / 904 354-4531 • FAX 904-354-7979 •
www.SargentCycle.com
Section [B]
| For
All Orders: |
| Seat
Height Version [ ]
High PFC-527 or
[ ] Low PFC-544 |
Standard
Upholstery Choices (check one):
[ ] CarbonFX Inserts, Black Welt and Black Trim
|
$374.95 |
[ ] CarbonFX Inserts, Silver Welt and Black Trim
- OR -
Non-Standard Upholstery* Choices:
[ ] CarbonFX
Inserts
[ ] Color Welt
- Please specify color: ____________________ |
$394.95 |
| Other
Options: |
|
| [
] Leather Inserts Front &
Rear*
Daytona or Smooth |
$55.00 |
| [
] BMW M-Sport Detail* |
$30.00 |
| *Restocking fees apply to non-standard
upholstery configurations and upgrades. |
|
| |
|
| |
|
Return Shipping and Handling (UPS GroundTrac Continental USA only). |
$19.95 |
Limited USPS Service is available for PO Box and Military
Addresses Only - $40.00
*Additional Shipping Charges may apply to large touring seats, oversized seats,
shipping to Alaska or outside the continental United States - CALL FOR PRICE. |
|
Sub-Total (Florida
Residents - add local county sales tax) |
|
TOTAL |
|
Section [C]
For New Orders Only:
Method of Payment |
[ ] Money Order [ ]
Personal Check (NOTE: Will be held
of 11 days.)
Credit Card: [ ] Discover [ ] MasterCard [ ] VISA [ ] American Express |
| Credit
Card #: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ |
| Name (as it appears on
the card): |
| Authorized Signature: |
| Expiration Date: __ __ /
__ __ |
| Billing Address: |
| City, ST, ZIP: |
| Home Phone: |
Sargent Cycle Products
North America
1036 Hubbard Street Jacksonville, FL 32206 • 1-800-749-7328 / 904 354-4531 • FAX
904-354-7979 • www.SargentCycle.com |