35
NO COD SERVICES
Duty and taxes are extra
Brokerage fees included
FedEx
FedEx ExpressSaver (3 day)
FedEx
FedEx Priority Overnight
on pgs 31-34.
Sales Tax in required states
I
ORDER
FORM
CLARK'S CORVAIR PARTS ®
PLEASE
400 Mohawk Tra
il
PR
I
NT
She
lb
u
rn
e Falls, MA 01370-9748
1.
We
go
only
by
CAT#
, so
give
complete
number
. Include all letters,
espec
ia
ll
y
Main Phone:
41
3-625-9776
Fax: 413-625-8498
Email clarks@corvair.com
Web site www.corvair.com
the
.Q.
, CU,
or
CX
before the numbers. Please use ink. Pl
ease
give
us
vour
ohone #.
2.
The back
of
this
order
form has a
Zone
Map. More order
in
fo ANY EXTRA
WILL BE REFUNDED -
indicate below. Pl
ease
indicate
how
to ship bel
ow
. Let
us
know
of
any
change in
your
address.
3. Payment (checks,
money
orders,
or
credit cards).
Make
payable to: Clark's Corvair Parts ®
Customer # EMAIL:
NAME
:
STREET:
CITY, STATE:
ZIP:
Q
lY
PART#
DESCRIPTION &
PAGE
COST
EA
$
¢
TO TA L
FO
R P
ARTS
I
VISA
" I
-
IE]
(16
Digits)
(16
Digits) (16 Digits) (15 Digits)
Ch
arge
my:
□
VISA
□ Mastercard
□
Discover
□
American Express
I I I I I I I I I I I I I I I I I
________________
Exp
Date
__
/
__
Customer Signature
Security Code
(V
i
sa
, Mastercard & Discover =
3 Digits
on
back/
Amex
= 4 Digits
on
front}
From
Cr
edi
t
Card
Statement: (for ad
dr
ess verification)
Street Address
____________
Zip
____
_
IDPlnQ
ress 1 1 eren
Sh" . Add "f D"
ff
TOTAL
Phone
:
$
¢
Lb.
oz
.
Home:
Day:
Fax:
·-··-··-··-··-··-··-··-
··-··-··-··-··
YEAR(S)
MODEL(S)
H
ORSEPOWER
TRANSMISSION
If OVER
$1
5 in INCREASES:
( ) Notify
you
( )
ADD
to
credit
card
If REFUND:
( )
Check
( )
Credit
on
account
ZONE
__
HOW TO
SH
IP
(C
hec
k
On
e)
( )
(grou
n
d)
( )
( ) (2
day
ai
r)
( )
( )
P
ost
Office
( )
U.S. P
rio
ri
ty
(a
ir
ma
il)
~
TOTAL
WE
I
GHT
in
LBS.
Please
Try for Mi
nimum
$20.00 Orders
Shipping
Postal
Insurance
(see
www.usps.com)
SUB - TOTAL
□
CREDIT or
□
AMOUNT
DUE
TOTAL ENCLOSED
35NO COD SERVICESDuty and taxes are extraBrokerage fees included FedExFedEx ExpressSaver (3 day)FedExFedEx Priority Overnighton pgs 31-34.Sales Tax in required statesI ORDER FORM CLARK'S CORVAIR PARTS (R) PLEASE 400 Mohawk Trail PRINT Shelburne Falls, MA 01370-9748 1. We go only by CAT#, so give complete number. Include all letters, especially Main Phone: 413-625-9776 Fax: 413-625-8498 Email clarks@corvair.com Web site www.corvair.com the .Q., CU, or CX before the numbers. Please use ink. Please give us vour ohone #. 2. The back of this order form has a Zone Map. More order info ANY EXTRA WILL BE REFUNDED -indicate below. Please indicate how to ship below. Let us know of any change in your address. 3. Payment (checks, money orders, or credit cards). Make payable to: Clark's Corvair Parts (R) Customer # EMAIL: NAME: STREET: CITY, STATE: ZIP: QlY PART# DESCRIPTION & PAGE COST EA $ ? TO TA L FOR PARTS I VISA" I -IE] (16 Digits) (16 Digits) (16 Digits) (15 Digits) Charge my: ? VISA ? Mastercard ? Discover ? American Express I I I I I I I I I I I I I I I I I ________________ Exp Date __ / __ Customer Signature Security Code (Visa, Mastercard & Discover = 3 Digits on back/ Amex = 4 Digits on front} From Credit Card Statement: (for address verification) Street Address ____________ Zip ____ _ IDPlnQ ress 1 1 eren Sh" . Add "f D"ff TOTAL Phone: $ ? Lb. oz. Home: Day: Fax: ?-??-??-??-??-??-??-??-??-??-??-??-?? YEAR(S) MODEL(S) HORSEPOWER TRANSMISSION If OVER $15 in INCREASES: ( ) Notify you ( ) ADD to credit card If REFUND: ( ) Check ( ) Credit on account ZONE __ HOW TO SHIP (Check One) ( ) (ground) ( ) ( ) (2 day air) ( ) ( ) Post Office ( ) U.S. Priority (air mail) ~ TOTAL WEIGHT in LBS. Please Try for Minimum $20.00 Orders Shipping Postal Insurance (see www.usps.com) SUB - TOTAL ? CREDIT or ? AMOUNT DUE TOTAL ENCLOSED
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