ORDER FORM

Date:
Name:
Address:
City: State: Zip:
Phone (Work):
 Best time to call:
Phone (Home):
Email Address:
Ship to address (if other than above)
Name:
Address:
City: State: Zip:
Chassis/Car Donor: Modal:  
Year : Regular  [   ]   Super   

QUANTITY

ITEM DESCRIPTION

ITEM PRICE

TOTAL PRICE
       
       
       
       
       

TERMS: 50% payment is required at time of order and FULL payment by shipment. All payments U.S. dollars only. All Truck/Freight charges are C.o.d. UPS charges are prepaid and assessed to customer. We cannot ship to a post office box or military post office address. Please arrange for independent address for shipment.

 Boxing Charge  
5% Tax (WI only)  
Net Total  

METHOD OF PAYMENT
Cashier’s Check or Money Order     [   ] Personal Check     [   ] VISA      [   ] MasterCard

Card Holder’s Signature
Card Number: Exp Date:

NOTE: 1) If this Order Form is not used, all information must be included in a letter with signature. (No verbal orders.)
            2) Personal/business checks require minimum two weeks approval delay.
            3) Credit Card payments require handling charges added to the buyer. (Ask for Details)