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www.NewChallengerStore.com
13721 Linden Drive.
Spring Hill, FL 34609
► Fax
number: 352 688 8153
Phone number: 352 688 8160 M-F 10:30am-4:00pm E.T.
Fax Order Form
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Part Name |
Part Price |
Shipping Price* |
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Products Sub Total |
Shipping Sub Total |
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$ |
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$ |
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*Orders to non-USA countries will have an
additional shipping charge.
We will add this to your total or
Call or email for rate. Overseas Shipping: |
$ |
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Add your two Sub Totals
above together for a Grand Total: |
$ |
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SAFETY: Your information is safe
with us. We do not provide your information to any third party
sources.
First and Last Name |
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Evening Phone Number: |
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Cell Phone Number: |
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Billing Address (according
to your Credit Card Statement) |
Street Address: |
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Apartment Number: |
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City: |
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State: |
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Zip Code: |
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Foreign Country: |
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Country Code:
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State Code: |
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Shipping Address is the same as billing address -
Check Box: |
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Shipping Address (If
different than Billing Address) |
Street Address: |
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Apartment Number: |
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City: |
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State: |
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Zip Code: |
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Foreign Country: |
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Country Code:
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Charge Card Information
This information is only used for this order. |
Name on YOUR Card: |
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Type of Card: |
VISA MC AMERICAN
EXPRESS DISCOVER |
Charge Card Number: |
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Charge Card Expiration date: |
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Three digit Code on the back of your card: |
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Your Signature:
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Today's Date: |
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Any Notes to us:
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Thank you for
your order!
We generally require 2-4 days for handling. Then we send your items
via:
US Priority Mail (2-3 days) insured. You will have to sign for the
package.
If you are not home the Post Office will hold it for you to pick up.
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