NORTHEAST CAPS.pdf - CollectorsAutoSupply.com
NORTHEAST CAPS.pdf - CollectorsAutoSupply.com
NORTHEAST CAPS.pdf - CollectorsAutoSupply.com
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ORDER FORM<br />
COLLECTOR'S AUTO SUPPLY<br />
6727 Thorne Rd, Peachland B.C. CANADA V0H 1H9<br />
Or: P.O Box 2076 Oroville Washington U.S.A. 98844<br />
PHONE: 1-250-767-1974 FAX: 1-250-767-3340<br />
E-MAIL: Jim@<strong>CollectorsAutoSupply</strong>.<strong>com</strong><br />
WEB: <strong>CollectorsAutoSupply</strong>.<strong>com</strong><br />
NAME:_________________________________________________<br />
STREET:_________________________________________________<br />
CITY:___________________________________________________<br />
ZIP/CODE:______________________________________________<br />
PHONE:________________________________________________<br />
FAX/E-MAIL:____________________________________________<br />
YEAR/MAKE/MODEL:____________________________________<br />
DISTRIBUTOR MAKE & NUMBER:__________________________<br />
(Helps ensure your order is correct.)<br />
ITEM DESCRIPTION ITEM # QTY. PRICE TOTAL<br />
:________________________________________:__________:_______:_________:_________<br />
:________________________________________:__________:_______:_________:_________<br />
:________________________________________:__________:_______:_________:_________<br />
:________________________________________:__________:_______:_________:_________<br />
:________________________________________:__________:_______:_________:_________<br />
:________________________________________:__________:_______:_________:_________<br />
:________________________________________:__________:_______:_________:_________<br />
C.O.D., VISA/MC Or CHEQUE TO: COLLECTORS AUTO SUPPLY SUB TOTAL:_______<br />
VISA/MC #:___________________________________<br />
EXPIRY DATE:____________<br />
SIGNATURE:_______________________ DOMESTIC SHIPPING: $7.00<br />
TOTAL:_________<br />
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