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NewGMParts.com

ORDER FORM
ORDER DESK
1-877-498-(Part)7278
 INTERNATIONAL Orders:
(508) 295-9095
 FAX:
1-508-295-0224

Quantum Sales
10 Kendrick Road
Wareham, MA 02571

INTERNATIONAL FAX: (508) 295-0224
TO ENSURE PROMPT DELIVERY, PLEASE TYPE OR PRINT CLEARLY

SHIP TO:
 BILL TO:
CUSTOMER #:
 CREDIT CARD ORDERS ONLY
NAME:
 NAME ON CARD:
C/O:
 ADDRESS:
ADDRESS:
 CITY:
CITY:
 STATE:ZIP:
STATE:ZIP:
 CONTACT PHONE: ()
DAY PHONE: ()
 VIN (Vehicle Identification Number)
HOME PHONE: ()
 YEAR/MODEL/ENGINE SIZE:


QTY
 PART #
 DESCRIPTION
 UNIT PRICE
 PRICE
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $

CARD #:
   Card Verification Value
CVV Code
Expitration Date:
 //
Card Holder Signature
 Shipping
 $
Foreign Orders Only
    
Bank Issuing Card: MA Res. add 6.25%
 $
Issuing Bank Telephone Number: Total Due
 $

FOR YOUR PROTECTION, WE THOROUGHLY INVESTIGATE THE VALIDITY OF ALL CREDIT CARD ORDERS!
If paying by check please allow extra time for delivery!
Please view the "Terms and Conditions" on the Order Policy page of our Web Site