Brandt's Harley-Davidson, Inc.
ORDER FORM
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ITEM NO.
DESCRIPTION & SIZE
PRICE
Your Name:             Total:
Address:
City, State, Zip:
Your Phone Number:
Your E-Mail:

*If not the same as above*
Ship To Name:
Ship To Address:
Ship To City, State, Zip:
PAYMENT INFO
-MasterCard | -Visa | -Check | -Money Order

Name on Card:
Credit Card Number: Ex. Date:

**With Item # and Size, PLEASE**
There is A FEE OF $10.00 FOR SHIPPING AND HANDLING ON ALL ORDERS!
Indiana Residents Please add 6% Sales Tax.
To place an order the Safest Way, Please fill out and print this page.

  • Then you may call us at (260) 563-6443
  • Fax it with your major credit card # to: (260) 569-1159
  • E-mail it to Brandts Merchandise Order
    With your major credit card # and Order Form as Attachment
  • You may send it with a Check or Money order to:
    Brandts H-D Online
    1400 N. Cass St.
    Wabash, IN 46992
    Thank you for your order! All Orders Shipped UPS Same Work Day Received...
    Brandt's Harley-Davidson, Inc.
    1400 N. Cass St.
    Wabash, Indiana 46992
    Phone:
    260-563-6443
    800-443-8105 (IN Only)
    Fax: 260-569-1159
    Order Merchandise or Questions?
    E-mail to:      brandtshd@verizon.net
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    Copyright © 2008 Brandts Harley-Davidson, Inc.