ORDER FORM


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You may also print this form and fax or mail it,
or call our toll-free number to order.
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Name: First: M:  Last: 
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Comments:
Year/Model of Vehicle: 
Driver Education:  Yes  No
Little People of America:  Yes No
Height:  feet   inches   Weight: 
Age:  Shoe Size:   Inseam: 

PART ID DESCRIPTION: PRICE: QTY:
 
For Individuals  2'7" - 4'7" needing 6" to 18" to reach the pedals:
    
GX0317
BX4518		 Gas & Brake Pedal Set - Length needed: Gas: Brake: $198.00
GBC-4545

Gas & Brake Pedal Set w/Clutch  Length: Gas:  brake: clutch:

(vertical measurement of clutch metal plate is needed because they come in different sizes) Circle the vertical distance taken after you have measured: 1.75" 2" 2 3/8" 2.5" 2.75"

 $278.00
GX0317 Single Gas Pedal Extender Length: $93.00
BX4518 Single Brake Pedal Extender Length: $105.00
BXCXGX4518 Toyota ForkLift Extenders (gas, brake, clutch), Length: $278.00
 
For Individuals 4'8" - 5'2" needing 2" to 5" to reach the pedals:
    
GXLB16 B
BX1618 B		 Gas and Brake Pedal Set - (4 inch base) (2 to 2.5") Length needed: $118.00
GXLB15 A
BX1618 A		 Gas & Brake Pedal Extenders (4 inch  base) (3 to 5") - Length needed: $128.00
GXLB15 EXL
BX1618 EXL		 Gas & Brake Pedal Extenders (4 inch  base)(4 to 6.5") - Length needed: $138.00
GX0318-EXL
BX1618-EXL 		Gas and Brake Pedal Extenders (4 inch base) (5.5 to 12") - Length needed:
(double pivot on gas extender - pedal pad can be pivoted to needed angel)		 $188.00
CXLB1615-B Standard Clutch - Length needed: 3 to 3.5" reach
(vertical measurement of clutch metal plate is needed because they come in different sizes) 		$78.00
CXLB1615-A Standard Clutch - Length needed: 5 to 6.5" reach
$88.00
CX1618-M Mazda Miata or BMW Clutch- Length needed: $78.00
BX1618 A or B Automatic Brake- Length needed: $76.00
1616 A or B Single Gas - Length needed: $60.00
1614 A or B Brake- Chevy Astro & GMC Safari - Length needed: $65.00
OSBP Over-Brake Pad - Chevy Astro & GMC Safari $28.00
 
PIANO EXTENDERS FROM 2 TO 16 INCHES:
    
PI24 Piano Extender: adjustable from 2 to 4 inches $35.75
PI48 Piano Extender: adjustable from 4 to 8 inches $45.75
PI96 Piano Extender: adjustable from 8 to 16 inches $55.75
 
 SHIPPING:
   
  US Postal Service - Priority Mail (2 -3 days Delivery Confirmation Receipt) $12.75
  FedEx Shipping  3rd Day Ground  $24.50
  FedEx Shipping  2nd Day Air $42.00
  FedEx Shipping Overnight (East Coast/depend on weight) $68.00
  COD add and additional FedEx delivery $15.50
  US Postal Express Air Mail to Europe, Australia, and New Zealand  (prices may vary on weight) $48.00
TOTAL Grand Total  Need a calculator? Click here!  

You May Also Order:

Between 7 a.m. and 8 p.m. - Pacific Western Time

Toll-Free 888.372.0153 (name, press # key) Ph: 818.324.5588

Or Print and and FAX this form to
818.247.3329

or Mail the completed form to:
Easy Rider Pedal Extenders ®
P.O. Box 251677
Glendale, CA 91225-1677 - USA

pedalextenders@yahoo.com

www.myspace.com/pedalextenders