Fillable Printable Order Form - Andy Bernbaum Auto Parts
Fillable Printable Order Form - Andy Bernbaum Auto Parts
Order Form - Andy Bernbaum Auto Parts
In a hurry? Not really
sure of what you need?
Order by telephone!
Most orders shipped same day.
93 Border Street
West Newton, Mass 02465
Information: 1-617-244-1118
Orders: 1-800-457-1250
Fax: 1- 617-244 -1164
Email: [email protected]
Catalog Number
Ship To: (Please print)
Shipping Address
Mailing Address if different
Telephone (Home)
Telephone (Work)
Credit Card ($25.00 minimum)
Exp. Date
Year Make Model
Body Style — Coupe, Sedan,
1/2-Ton, Wagon, etc.
Number of Cylinders Engine Number
4, 6, or 8
Serial Number
Other Data: Distributor Number, etc.
Name of Cardholder (print)
Signature of Cardholder (Required)
PRICE / each
PAGE QTY. PART NUMBER DESCRIPTION TOTAL
pair / set
Please Note: Personal checks are welcome. Please allow delay in shipment for bank clearance.
U.S.A. shipping and handling (48 states) please include 10% of amount in subtotal box, minimum $11.00.
Outside U.S.A. 20%, minimum $25.00.
For special instructions please use the back of this form. If you need an item not covered in this catalog, please call 1-617-244-1118,
or be very specic about the part(s) on the back of this form. We have over one million new and new old stock parts covering Chrysler
products from 1929 to 1976 available to you.
CUT HERE . . . A NEW ORDER BLANK WILL BE SENT WITH YOUR ORDER
SUBTOTAL
Mass. RES.
6.25% Tax
Core
Charge
Shipping
& Handling
TOTAL
ORDER BLANK
3 or 4 Digit
V Code
