nnCHECK OR MONEY ORDER
nnMASTERCARD
nnVISA
CREDIT
CARD
NUMBER:
AMOUNT $ _____
ORDERED FROM CATALOG
(SHOWN ON COVER) DATE
NAME
ADDRESS
CITY S TAT E Z I P
PHONE NUMBER DAY/ AREA CODE NIGHT/ AREA CODE
CAR SPECIFICATIONS: YEAR:____ METHOD OF PAYMENT
ARE WE SHIPPING TO: nn RESIDENCE nn BUSINESS
QTY PRICE TOTAL
ORD PART # DESCRIPTION EACH PRICECREDIT CARD BILLING ADDRESS SUBTOTAL
TA X
SHIPPING
TOTAL
nnCOUPE nnSTANDARD INTERIOR nn4 CYLINDER nnBENCH SEATnnCONVERTIBLE nnDELUXE SS INTERIOR nn6 CYLINDER nnBUCKET SEATSnnSTATION WAGON nnWITH CONSOLE nnV8 SMALL BLOCK nnAUTOMATIC TRANSnnSUPER SPORT nnAIR CONDITIONING nnV8 BIG BLOCK nnMANUAL TRANSnn nn nn2 BBL nn4 BBL Expiration Date Valid to: _____ yr _____
No returns after 30 days.NAME
ADDRESS
CITY STATE ZIP
Car Shop Inc. 739 North Batavia Orange, California 92868
Fax Order 1-714-771-0407 • Toll Free 1-800-235-2470 • http://www.TruckandCarShop.com