Please print this
form for your mail or fax orders! (Not for use on-line) Click your BACK button to continue when you are finished with this page. | ||||
Fun Imported Auto and Toys |
ORDER FORM | |||
|
143 Tunnel
Road Vernon, CT 06066 |
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 |
$ |
FOR YOUR PROTECTION, WE THOROUGHLY INVESTIGATE THE VALIDITY OF
ALL CREDIT CARD ORDERS!
If paying by check please
allow extra time for deilvery!