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Deposit Form

* Full Name:
* Email Address:
* Phone Number:
* Salesperson:
* I am making a deposit to purchase the following unit:

Entering your name below constitutes your electronic signature for the deposit, and confirms that:

You understand that the deposit is non-refundable.
You understand that this deposit is good for up to 30 days from date of deposit. Deposits more than 30 days old may be considered forfeited by the card holder. This decision is at the discretion of Interstate Cycle.
You understand that once we receive your signed Deposit Agreement we will charge your credit card one time for the stated deposit amount.
You understand that the deposit will be used towards the final purchase price of the unit you are purchasing from Interstate Cycle.

*	By checking this box, I certify that I have read and agree to the conditions above and I concur that all the information I have given is true and correct. The credit card is in my name with the billing address the same as listed above. I hereby authorize Interstate Cycle to charge my credit card for the deposit.

* Date:
* Electronic Signature:

* These fields are required