PRINT AND MAIL / OR FAX AT (814) 833-8562
Pay with Mastercard, Visa, American Express, Discover, Personal check or PayPal !
ORDER FORM
PRINT AND
MAIL / OR FAX AT (814) 833-8562
Pay
with Mastercard, Visa, American Express, Discover, Personal check
or PayPal !
MASTERCARD _____ VISA____ AMERICAN EXPRESS _____
CARD NUMBER __________________________________ EXP _____/_____
FOR VISA ,
MASTERCARD , DISCOVER:
AVS # (LAST THREE DIGITS IN THE SIGNATURE PANEL ON THE REVERSE
OF CARD) ____ ____ ____
FOR AMERICAN EXPRESS:
FOUR DIGIT CODE ABOVE TO THE RIGHT OF THE CARD NUMBER ON THE FRONT
OF THE CARD ____ ____ ____ ____
SIGNATURE
___________________________________
NAME AS IT APPEARS ON CARD: __________________________________________
BILLING ADDRESS : ___________________________________________
_________________________________
_______ __________
PLEASE NOTE
THAT ALL PRICES INCLUDE UPS GROUND SHIPPING. PLEASE CALL FOR
ADDITIONAL FREIGHT CHARGES OUTSIDE OF THE CONTINENTAL US AND DUTIES.
MODEL # QUANTITY COST EACH TOTAL
_______ _________ $ _________ $_________
_______ _________ $ _________ $ _________
_______ _________ $ _________ $ _________
TOTAL . . . . . . . . $ _________
DISCOUNTS AVAILABLE WHEN ORDERING (2) OR MORE OF THE SAME DISPLAY CASE
SHIP TO IF DIFFERENT FROM BILLING ADDRESS:
_______________________________________________________
_______________________________________________________
____________________________ _____ ________________
MAKE CHECKS
PAYABLE TO:
TRACKSIDE
MARKETING
SERVICES
P.O. BOX 137 FAIRVIEW. PA. 16415
CALL TODAY : (814)
838-3152
FAX ORDERS TO : (814) 833-8562
CHECK HERE
IF YOU WOULD LIKE A FAX ORDER CONFIRMATION SENT ___
FAX NUMBER _____ - _____- __________
E-MAIL US AT . . .
. . . .trackside1@earthlink.net
CHECK
HERE IF YOU WOULD LIKE AN EMAIL ORDER CONFIRMATION SENT ___ EMAIL
__________________________
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