AUTO BODY SPECIALTIES, INC. ORDER FORM
P.O. BOX 455, Middlefield, CT 06455 | Fax: 860-346-4987 | To Order Toll Free: 888-277-1960
For Information: 860-346-4989 | www.AutoBodySpecialT.com

BILLING ADDRESS

 SHIPPING ADDRESS (if different)

Customer #

  

Name

 Name

Address

 Address

City

 City

State

 State

Zip Code

 Zip Code

Daytime Phone

 Daytime Phone

Year

 Make Model
Conv. 2-Door Hdtp. 4-Door 2-Door Sedan Hatchback Etc.
Front Back   Left Side (Driver) Right Side (Passenger)
QTY SIDE PART NUMBER DESCRIPTION UNIT PRICE TOTAL PRICE

 

          

 

          

 

          

 

          

 

          

 

          

 

          

 

          
CIRCLE THE CARD OF YOUR CHOICE:

IMPORTANT! COPY ACCOUNT NUMBER FROM YOUR CARD :

CARD #______________________________________________________

EXPIRATION DATE: ____/____

_____________________________________________________________
CARDHOLDER'S SIGNATURE

_____________________________________________________________
CARDHOLDER'S PHONE NUMBER

_____________________________________________________________
PRINT CARDHOLDER'S NAME AS APPEARS ON CARD
SUBTOTAL:
  
SHIPPING:
(Call for Quotes: Toll Free: 1-888-277-1960)
  
TAX:
6% Sales tax on parts and shipping
(CT residents only)
 
TOTAL:
  

____________________________________________
CUSTOMER SIGNATURE

____________________________________________
DATE

BANK CHECK ENCLOSED
MONEY ORDER ENCLOSED
COD

(UPS requires money order or bank draft)

 *Merchandise not returnable after 30 days.
*No returns on special order parts.
*Advise how shipment is to be made: truck freight or UPS. We will ship COD on UPS orders only.
*We hold personal and company checks until bank clearance.
*Prices are subject to change.
*Please call for current prices before ordering.
NOTE: Please call for pricing on all overseas shipments