Helmets Etc.
5656 Isablle Avenue
Suite 3-C
Port Orange, FL 32127

FIRST NAME: _________________________ MI:______ LAST NAME:____________________________________

*BILLING ______________________________________________________________________________________
ADDRESS

_______________________________________________________________________________________

CITY: _____________________________ STATE/PROVINCE: ______________________ POSTAL CODE: ______

COUNTRY:______________________________

EMAIL: _________________________________________________________________________________________

TELEPHONE:_________________________________ FAX:_______________________________

CARD TYPE (circle one): VISA MASTERCARD AMX DISCOVER

CARD NUMBER:_______________________________________________________________________________

EXPIRY DATE:_______________________________ **CVV CODE:______________________________________

GUANRANTEE
The undersigned Guarantor in order to induce Helmets Etc,. Inc. to process the order herein, does hereby unconditionally personally guarantee all sums which may be owed by applicant to Helmets Etc., Inc. whether said indebtedness is due now or hereafter incurred. This guaranty is continuing, and shall continue to apply to all indebtedness which applicant may hereafter incur, renew or extend in whole or in part, with Helmets Etc., Inc. all without notice to the undersigned Guarantor. The undersigned Guarantor waives notice of acceptance of this Guaranty. The undersigned Guarantor promises to pay the indebtedness and obligations incurred hereunder at South Daytona, Volusia County, Florida, United States.


PRINT NAME AS IT APPEARS ON CREDIT CARD:

_____________________________________________________________________________________________

AUTHORIZED SIGNATURE _______________________________________________DATE:_______________

* Billing address information must match the information provided by the Credit Card issuer. For orders outside the USA we will ship to the verified billing address only. No exceptions.

** The CVV code is required information for processing your order. The order will not be processed without it. The CVV code is the last 3 digits located on the signature panel of Mastercard, Visa and Discover on the back of the card. American Express CVV is 4 digits stamped on the front of the card above the Credit Card Number.