The Carburetor Shop LLC

 

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Orders by email

 

For those of you who are responding to an email, and placing a order by email; PLEASE print this page, fill out the entire page and send by email. IF USING THIS FORM, PLEASE TYPE! WE WILL NOT ACCEPT A HANDWRITTEN ORDER. IF YOU CANNOT TYPE, PLEASE CALL INSTEAD. This page may seem too specific, but it has been designed for our non-USA customers.

 

Company name (if applicable) ___________________________________________________________

 

First name or initial (required) ___________________________________________________________

 

Last name (required)  _________________________________________________________________

 

Shipping address – building (if applicable) _________________________________________________

 

Shipping address – street (required) ______________________________________________________

 

Shipping address – city (required) _______________________________________________________

 

Shipping address – state, province, prefecture, etc. (required) __________________________________

 

Shipping address – country (required) ____________________________________________________

 

Shipping address – postal code (zip code in USA) (required) __________________________________

 

VISA or MasterCard number (we accept no other cards) (required) _____________________________

 

Expiration date of card (required) _______________________________________________________

 

Security code (on the back of card – required)_____________________________________________

 

Billing address for the card (required if different from shipping address) _________________________

 

Billing address second line (if needed) ___________________________________________________

 

Daytime telephone number (required for shipments outside the USA)  ___________________________

 

The item(s) you are ordering and prices quoted in the email ___________________________________

 

 

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