PRODUCT ORDER FORM

MIA PATRIOT GOLF CART
$20.000

If you would like to make a personal order of up to 3 MIA PATRIOT CARTS, please fill out this form and we will be in contact with you within 48 hours with more details. If you are a reseller and would like more than 3 carts, please contact us at contact@mia-patriot.com.

Name *

First

Last

Email *

Phone Number

Golf Cart Quantity * For order over 3, please fill out the 'Become a Reseller' form for bulk discounts

Delivery *

Shipping

Shipping available in the continental United States for an additional fee

Shipping Address *

City *

State / Province / Region *

Postal Code *

Country *

Special Delivery Instructions *

Confirmation *

I acknowledge that I have read and agree to abide by the Terms and Conditions

I acknowledge that upon submitting this form, my orders are not final and I will be contacted with more detials

PRODUCT ORDER FORM

MIA PATRIOT GOLF CART $20.000

MIA PATRIOT GOLF CART
$20.000