Order Form for Fun Imported Auto and Toys

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ORDER DESK :
860-871-1990

FAX :
860-875-0601

143 Tunnel Road
Vernon, CT 06066

TO ENSURE PROMPT DELIVERY, PLEASE TYPE OR PRINT CLEARLY

SHIP TO:
BILL TO:

CUSTOMER #:
CREDIT CARD ORDERS ONLY

NAME:
NAME ON CARD:

C/O:
ADDRESS:

ADDRESS:
CITY:

CITY:
STATE and ZIP

STATE and ZIP:
CONTACT PHONE: (_____)

DAY PHONE: (_____)
Trans Type:___AUTO ___4-Spd ___5-Spd

HOME PHONE: (_____)
YEAR/MODEL/ENGINE SIZE:

QTY
PART #
DESCRIPTION
UNIT PRICE
PRICE

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $
$20 MINIMUM ON ALL CREDIT CARD ORDERS

CARD #:
Shipping
$

Expitration Date:
Month: _______ Year: _______ If COD
$6.00

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 deilvery!

SHIP TO:	BILL TO:
CUSTOMER #:	CREDIT CARD ORDERS ONLY
NAME:	NAME ON CARD:
C/O:	ADDRESS:
ADDRESS:	CITY:
CITY:	STATE and ZIP
STATE and ZIP:	CONTACT PHONE: (_____)
DAY PHONE: (_____)	Trans Type:___AUTO ___4-Spd ___5-Spd
HOME PHONE: (_____)	YEAR/MODEL/ENGINE SIZE:

QTY	PART #	DESCRIPTION	UNIT PRICE	PRICE
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$

CARD #:		Shipping	$
Expitration Date:	Month: _______ Year: _______	If COD	$6.00
Card Holder Signature		CT Res. add 6%	$
Bank Issuing Card		Total Due	$