BOXER4RACING FAX ORDER FORM
Fax this form to (828) 683-6457 International orders click here
**All Fields Must Be Completed Please Print or Type**
***Before you order review our terms and conditions page***
Credit Card Billing Address:

Name: Day Phone:
Street Address: Eve. Phone:
City: E-Mail:
State:                                                                                                               Zip Code:  

Vehicle Year:

Vehicle Make:

Vehicle Model:

Vehicle Body Style:
       

Name as it appears on card: V Code (Last 3 digits on the back of card):
Card Number: Expiration Date:

Item Description

Price

Qty

Total
  $   $
  $   $
  $   $
  $   $
  $   $
  $   $

Sub-total

 $

Shipping

 $

Total

 $

**PRICES DO NOT INCLUDE SHIPPING AND HANDLING PLEASE EMAIL FOR SHIPPING QUOTES**
We ship via UPS and Fed Ex
We recommend qualified technicians install all parts. Please allow at least 5-7 business days for delivery. Special orders or out of stock items will take longer. If you have any questions feel free to call (828) 683-9218 M-F 9am-5pm Eastern Standard Time.

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Signature (Order will not be processed without this)                                         Date