This is not a secure server for sending credit card information. Please fax this order form if you would like to purchase. No phone orders! No email orders! Fax Orders only!
 We do not ship C.O.D.
A CLEAR COPY OF YOUR CARD AND YOUR DRIVERS LICENSE MUST ALSO BE FAXED WITH THIS COMPLETED ORDER FORM.
Thank you.

Please complete this form, print it, and fax it to 314-382-9583.
Order Form
Business Name
Attention
Address
City / State / Zip
Phone Fax
Email Address
#
Expires
SHIP TO: (if different than mailing address)
Business Name
Attention
Address
City / State / Zip
PART REQUESTED:
Year Make / Model
Side Needed Option Needed
Part Needed
Price Quoted $ Freight Quoted $
ALL QUOTES ARE FOR BUSINESS DELIVERY!
RESIDENTIAL DELIVERY WILL BE ADDITIONAL! UPS ground $5.00, Trucking $75.00
Warranty Quoted
Signature x_____________________________________ Date
A signature is required for the processing of this Order Form