FAX ORDER SHEET
Date:__________.............................. E-Mail
Address: _______________________
Bill to:
_______________________ Ship to (if different):
_______________________
.........._______________________............................
_______________________
.........._______________________ ............................_______________________
.........._______________________............................
_______________________
Phone: ______________________
.................... Fax:
_______________________
Payment Method: Credit Card:
_______-_______-_______-_______ Exp.______
(Signature)___________________________________Date: _________________________________
PayPal: Submit to george@rpmoutlet.com
VEHICLE:
Year: __________ Make:
__________ Model: __________ Trans type:
__________ Engine Size: __________
Product:
Part#: __________ ..Description: _______________________
..Price: ________
Part#: __________ ..Description: _______________________
..Price: ________
Part#: __________ ..Description: _______________________
..Price: ________
Part#: __________ ..Description: _______________________
..Price:
________
