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 ___________________________________