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| ORDER FORM:
FAX TO 765-647-1252 OR ATTACH THIS PAGE TO EMAIL
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TRUCK MAKE: __________________ |
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TRUCK YEAR: ______________ |
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TRUCK MODEL: _________________ |
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TRUCK SERIAL #: _____________________________ |
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(Serial number is on sale paperwork or can be found on driver's side of cab.)
DESCRIPTION OF PART NEEDED:
DESCRIPTION OF ACCESSORY OR CUSTOMIZING NEEDED:
Authorized Signature of Buyer:
_________________________________________
| Print Name Here: __________________________________________________________ |
Date: ____________________________________ |
| Payment Method: |
Cash ____ |
Cashier's Check ____ |
Money Order ____ |
or if Credit Card via Online Pay Pal:
NAME OF CREDIT CARD: We accept MasterCard ____ or Visa ____
NAME ON CREDIT CARD: ________________________________________________ EXP DATE: ________________________________
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