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Print this orderform, fill it out completely and fax it to
our 24 hour fax line at 1-800-519-RACE. Your order will be shipped the next business day. All of your information is kept strictly confidential. CUSTOMER INFORMATION:First Name:_________________________Last Name:_________________________ Mailing Address:________________________________ ___________________________________________________ ___________________________________________________ Daytime Phone#:(____)___________________ Social Security # (for US Customs):_________________________ Have you ever bought from us before? YES NO Where have you seen us advertised:_________________________ Are you the builder? YES NO Are you the driver? YES NO Your Age for our statistics:_____ SHIPPING INFORMATION:This must be a business address. If you don't have a business to deliver it to CALL US! we'll ship it to the local Terminal and save you the extra $83. Residential charge.Company Name:_____________________________ Address:___________________________________________ ___________________________________________________ Business Phone #:(____)______________ Contact Person:_______________________ PAYMENT INFORMATION:VISA-Mastercard#:_________-__________-__________-__________The 3 digits at the end of the signature strip on the back of your card:__ __ __ Expiry Date: MONTH________YEAR_________ Your name as it appears on the card:____________________________ Cardholders Signature:_________________________ |
| PART NUMBER | DETAILED ITEM DESCRIPTION | # | PRICE |
|---|---|---|---|
| # | * | # | $ |
| # | * | # | $ |
| # | * | # | $ |
| # | * | # | $ |
| # | * | # | $ |
| # | * | # | $ |
| TOTAL | $ | ||