Replacement Parts List
NOTE:
If requested color is not available, similar color will be
substituted.
Part Cost Quantity Total Cost
Buckle Assembly ..........$6.99 X ______ = $ ______________
Belt Loop (1)* ..............$2.00 X ______ = $ ______________
UAS Belt (1)* ...............$4.50 X ______ = $ ______________
Seat Pad ...................$19.99 X ______ = $ ______________
Locking Clip ................$2.50 X ______ = $ ______________
“S” Clip (1)* .................$2.00 X ______ = $ ______________
Instructions ..................$0.00 X ______ = $ ______________
*2 are required to use this car bed
Merchandise Total $ ________________
Shipping and handling:
$ ________________
Sales Tax:
.............................................................. $
_______
Residents of Quebec, add 5% GST and 9.975 PST%.
Residents of New Brunswick and Newfoundland and Labrador, add 15% HST.
Residents of Nova Scotia add 15% HST.
Residents of Saskatchewan add 5% GST and 5% PST.
Residents of Manitoba add 5% GST and 8% PST.
All other Provinces and Territories, add 5% GST.
Grand Total:
........................................................... $
_______
No shipping and handling on instructions for quantities under 6. Add $.50 for each
instruction over 6, then add applicable shipping and handling.
Fill Out For Credit Card
q
Visa
q
MasterCard
Card Exp. Date: ___________________________________
Cardholder’s Name: _______________________________
Card Number: ____________________________________
Signature:__________
_____________________________
Up to $25.00 ....................... $5.95
$25.01 to $50.00 ................ $6.95
$50.01 to $75.00 ................ $8.95
$75.01 to $100.00 .............. $9.95
$100.01 to $150.00 ............ $10.95
$150.01 to $200.00 ............ $11.95
$200.01 and up ................. $13.95
Outside Continental USA and
Canada ................................$10.00
CUT ON DOTTED LINE
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