Bill To:

 Ship Parts To:

Name:______________________________________
Address: ___________________________________
___________________________________________
City:_______________ State:_______Zip:_________

Name:_______________________________________
Address:_____________________________________
____________________________________________
City:_______________ State:_______ Zip:_________

Day Phone:__________________________

Evening Phone:_________________________

Email address: ____________________________

Description of Parts:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Total Number of Pieces in Shipment: ________

Coating Process and Color:_____________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Payment Options:

__ COD (We will call you with the total)

__ Credit card (We will call you for the number)

Ship via:

___ UPS Ground ___ UPS 2nd Day Air ___ UPS Next Day Air
___ Other___________________________________________________________________________________

Special Handling Instructions:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________