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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

Part Number	Part Name	Part Price	Shipping Price*
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
		Products Sub Total	Shipping Sub Total
		$	$
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:*			$

Add your two Sub Totals above together for a Grand Total:			$

SAFETY: Your information is safe with us. We do not provide your information to any third party sources.

First and Last Name
Evening Phone Number:
Cell Phone Number:
Billing Address (according to your Credit Card Statement)
Street Address:
Apartment Number:
City:
State:
Zip Code:
Foreign Country:
Country Code:
State Code:
Shipping Address is the same as billing address - Check Box: ⁪

Shipping Address (If different than Billing Address)
Street Address:
Apartment Number:
City:
State:
Zip Code:
Foreign Country:
Country Code:
Charge Card Information This information is only used for this order.
Name on YOUR Card:
Type of Card:	VISA MC AMERICAN EXPRESS DISCOVER
Charge Card Number:
Charge Card Expiration date:
Three digit Code on the back of your card:
Your Signature:
Today's Date:
Any Notes to us:
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.