Order Form
PO Box 471 Order # _________________________________
Midland, NC  28107 Bill to: _________________________________
    _________________________________
Phone:  (704) 888-3607   _________________________________
Fax:  (704) 888-6581   _________________________________
    _________________________________
Date: _________
Ship to: _________________________________ Contact name: ____________
_________________________________ Phone number: ____________
_________________________________ Best time to call: ____________
_________________________________ Chevy car model & year: ____________
_________________________________ Exterior & Interior colors: ____________
Payment Type:
Charge: Visa _  M/C _  AmEx _  Disc _

 Card number:

__________________________

Check: __

 Expiration date:

________

Money Order: __

 Signature:

__________________________


Part # Qty. Description Price Ea. Total Amount
         

Subtotal:  _____________
Tax rate for NC residents:  7%  ------------------>            Tax:  _____________
**Shipping & Handling:  15% (min. $9.00)  ------------------>   Shipping:  _____________
TOTAL:  _____________

**** Shipping is for standard UPS, USPS or DHL Express Ground. Some items ship oversize DHL Express or Overnite Transportation Motor Freight and require extra shipping. Please call for actual shipping charges on large orders.

Ordering Information -- Terms and Conditions

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