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This order form is a FAX
435-687-9239 or snail mail
your order to us |
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Today's Date:
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Year & Body Style of
Car: |
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Your
Name: |
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UPS ship to/Del. address |
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City/State/Zip |
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AC & Phone# |
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PRINT Your EMAIL address: |
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Card
Billing Name: |
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Card
Billing Address: |
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Card City/State/Zip: |
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Card AC & Phone: |
We accept Visa, MasterCard, Discover. Place the 16 numbers below & Expiration
date. |
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_____________/______________/_______________/________________/exp.______/_______ |
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Please sign your name
here:________________________________________V-Code______
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Name of Part |
Item #
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Price of Part |
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Sub-Total |
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Shipping |
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MADE IN THE USA~Total Amount
Due USA FUNDS ONLY $ |
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We pay UPS ground on FULL WOOD KITS
in the 48 states. You pay for UPS for individual items. |
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Utah
residents
must pay 5.95% sales tax |