AMERICANA SOFT SEATS ORDER FORM

                                       

              amsss116@gmail.com      www.amsss.com       

                 Please Print (CTL P) and Include this Order Form in with the seat and payment.  

Name__________________________________________________________

Address________________________________________________________

City _________________State_____________ ZIP______________________

Email______________________________   Telephone___________________

Motorcycle Data    Year _____________  Make _______________________  Model  _______________________

Personal Data Driver         Height ___________    Weight ____________   

Personal Data Passenger     Height ___________    Weight ____________    

Special Instructions_______________________________________________________________________________

Shave back Tailbone section(  )  Lower Riding Position(  )  Raise Riding Position(  )  Soft(  ) Medium( )  Firm(  )

We will call you prior to doing any seat modifications

Money Order,      Cashiers Checks,      Personal Checks Accepted      PayPal    

Please make payment out to '  J. Agostisi

3 Layer Visco Gel Memory Foam Installation,  

Driver Seat Only

$229 Sale  $199

3 Layer Visco-Gel Memory Foam Installation,   

Driver & Passenger Seats    

$259 Sale  $229

Aftermarket Seats  (Corbin, Mustang) and OVER SIZED Seats 3 Layer Visco- Gel Memory Foam Installation, GoldWing, CanAmm , Scooters

$279 Sale $259

Sub Total

 

Shipping

       $42.95

            $42.95
Please make payment out to              J. Agostisi Total Price
DISCLAIMER. We guarantee our Visco Gel Memory Foam products, WE CANNOT GUARANTEE THAT A GEL PAD AND MEMORY FOAM INSTALLATION WILL SOLVE ALL YOUR RIDING DISCOMFORT. EVERY INDIVIDUAL IS BUILT DIFFERENTLY AND EVERY ONE WILL GET DIFFERENT RESULTS. All customers that agree into a purchasing agreement for our custom reupholstering service agrees to this warranty and limitations of liability. We do not accept responsibility if your parcel (seat) is lost once the Shipping Service has it in their possession.  We will send tracking information when shipped.
** We do not guarantee that aftermarket seat covers will look the same as the OEM Seat cover.** 
** All return shipping will be the responsibility of the customer.
If possible be use UPS or FedX for shipping.

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Shipping Label

___________________________________________________________________
To:  J.Agostisi @ AMSSS
97177 Bluff View Cir
Yulee FL.32097