| SELLER: | BILL TO: | ||||||||
| CUSTOMER #: | CREDIT CARD ORDERS ONLY | ||||||||
| NAME: | NAME ON CARD: | ||||||||
| ADDRESS: | |||||||||
| ADDRESS: | CITY: | ||||||||
| CITY: | STATE:  ZIP:
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| STATE: ZIP:
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CONTACT PHONE: ( ) | ||||||||
| PHONE: ( ) | ENGINE SIZE: | ||||||||
| E-MAIL ADDRESS: |
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| Please print this form and mail in your advertising order. Use your browser's BACK button to return to Dixie Monte Carlo Depot.
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| Dixie Monte Carlo Depot | SALES FORM | ||
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60A Progress Dr. Manchester, CT 06042 |
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| SELLER: | BILL TO: | ||||||||
| CUSTOMER #: | CREDIT CARD ORDERS ONLY | ||||||||
| NAME: | NAME ON CARD: | ||||||||
| ADDRESS: | |||||||||
| ADDRESS: | CITY: | ||||||||
| CITY: | STATE: ZIP:
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| STATE: ZIP:
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CONTACT PHONE: ( ) | ||||||||
| PHONE: ( ) | ENGINE SIZE: | ||||||||
| E-MAIL ADDRESS: |
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| Please COMPLETE the information below to ensure the best possible support for your advertised car or car parts sales! Include upto 3 photos as STANDARD, extra photos $5.00 each. | |
| ASKING PRICE: | |
| YEAR & MODEL: | |
| MILEAGE: | |
| INTERIOR COLOR/MATERIAL: | |
| EXTERIOR COLOR/TRIM: | |
| * OPTIONS: (A/C, sunroof, spoiler, stereo, etc) |
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| * DESCRIPTION: (upgrades to the car, current condition, etc) |
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| CARD #: |  |
Basic Advert Cost | FREE! | ||
| Expiration Date: | / / | Extra Photos | $ | ||
| Card Holder Signature | CT Res. add 6% | $ | |||
| Bank Issuing Card | Total Due | $ | |||
FOR YOUR PROTECTION, WE THOROUGHLY INVESTIGATE THE VALIDITY OF ALL CREDIT CARD ORDERS!
If paying by check please allow extra time for clearance!
Please view the "Terms and Conditions" on the For Sale Page of our Web Site.
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