Secure Form

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Use this secure form if your browser is having difficulties with our Shopping Cart or if you would like a Recumbent Catalog or an Accessory Order shipped to an International Address. Please follow the instructions below carefully.

Your Full Name:

Your E-mail Address:

Please enter your BILLING / MAILING address exactly as it
should appear along with your Phone Number:

Please enter your SHIPPING address exactly as it should
appear (leave blank if same as Billing Address):

Check here if you would like a Recumbent Catalog - Free to North America (USA, Canada, Mexico),
$5.50 to the rest of the world without accompanying accessory order - please include Credit Card Information below.

If this form is regarding an online order you have already placed with us, please enter your Order ID
number here. Your Order ID can be found in the upper right of your order confirmation email message.
Order ID:

Please type your order or request here. If ordering from our catalog, be sure to include the part number,
the quantity you would like, and a short description of the item.
PART# QTY DESCRIPTION ----- --- ----------- 00000 1 Hostel Shoppe Recumbent Catalog

Credit Card Information: Please be accurate!

Visa
MasterCard
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Account Number:


Expiration Date:


Card Owner: (as appears on Card)

CV2 Code: (Security code in Signature box on back of Card)

We will process your order request and contact you via email regarding shipping and handling charges and your order total.

Be sure to double-check your information, especially your email address, so that we may contact you with any questions.

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