Solutions Guide Revision 5
716-759-8666 • [email protected]
R
EPLACEMENT
P
ARTS
ORDER FORM
D
ATE
: __________________________
C
USTOMER
#
(from receipt):
____________
ORDERED BY:
N
AME
: _______________________________
C
OMPANY
: ____________________________
S
TREET
: ______________________________
C
ITY
: ___________ ST: ____ ZIP: _________
D
AY
P
HONE
: ___________________________
F
AX
: _________________________________
E-M
AIL
: ______________________________
SHIP TO:
N
AME
: _______________________________
C
OMPANY
: ____________________________
S
TREET
: ______________________________
C
ITY
: ___________ ST: ____ ZIP: _________
D
AY
P
HONE
: ___________________________
F
AX
: _________________________________
E-M
AIL
: ______________________________
VEHICLE INFORMATION:
T
YPE OF
A
UTOMOBILE
: _________________________
Y
EAR
______ E
NGINE
: __ 4
CYL
. __ 6
CYL
. __ 8
CYL
.
TYPE OF DRIVING:
__ S
TREET
__ R
ACING
__ S
TREET
& S
LALOM
__ S
TREET
M
ODIFIED
Q
UANTITY
P
ART
#
D
ESCRIPTION
U
NIT
P
RICE
A
MOUNT
METHOD OF PAYMENT:
__ C
HECK
/
MONEY ORDER
__ V
ISA
__ M
ASTER
C
ARD
__ D
ISCOVER
__ A
MEX
C
REDIT
C
ARD
#: _____________________________ E
XP
: _____________
S
IGNATURE
: ___________________________________________________
Price subject to change without notice. Not responsible for typographical errors.
NOTE: Name, address & telephone number must be printed on checks. Driver’s License number
required for personal checks.
Total Merchandise
NY Residents Sales Tax
Ins.
(add $0.35 per $100.00)
UPS Shipping
(please call)
TOTAL
FREE FREIGHT
IF ORDERED WITHIN 30 DAYS OF INITIAL ORDER
MAIL OR FAX YOUR ORDER!
ORDER INFORMATION:
6
Stainless Steel Brakes Corporation
11470 Main Road • Clarence, NY 14031
Ph: 716-759-8666 Fx: 716-759-8688
ssbrakes.com • [email protected]
Содержание A113-1
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