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PLEASE PRINT THE FORM AND SEND YOUR ORDER BY FAX. 1-617-244-1164

Information :
1-617-244-1118
Orders Only :
1-800-457-1250

ORDER BLANK


315 Franklin Street
Newton, Mass 02458

In a hurry?
Not really sure of what you need?
Order by telephone!
Most orders shipped same day.
Ship To: (Please print) Year Make Model
Shipping Address Body Style - Coupe,Sedan,
1/2-Ton, Wagon, etc
  Number of Cylinders Engine Number
Mailing Address if different Serial Number
  Other Data: Distributor Number, etc.
Telephone (Home)
Credit Card ($25.00 minimum)        
Credit Card Number                         		Expiration Date:  3- or 4-Digit
CVV Code:
                               
/  
Telephone (Work)
Name of Cardholder (print) Signature of Cardholder (Required)
QTY
PART NUMBER
DESCRIPTION
PRICE
each pair/set
TOTAL
         
         
         
         
         
         
         
         
         
         
         
         

Please Note: Personal checks are welcome. Please allow delay in shipment for bank clearance. Massachusetts residents please add 5% sales tax.

U.S.A. shipping and handing (48 states) please include 10% of amount in subtotal box, minimum $10.00. Some smaller orders cannot be shipped for the minimum shipping charge, so we may need to increase that charge.  Outside U.S.A. approximately 20%, minimum $25.

If you need an item not covered on this website, please call 1-617-244-1118, or be very specific about the parts you need on a separate sheet of paper We have over one million new and new old stock parts covering Chrysler products from 1929 to 1976 available to you.

SUBTOTAL  
Core Charges  
Shipping &
Handling		  
TOTAL