DBW Dodge Truck Parts ORDER FORM:(Print-then mail or call)

NAME:____________________________________________________________________ DATE: __ __-__ __-2016

ADDRESS:________________________________________________________________ ($5 FEE FOR P.O. Box)

CITY: _______________________________ STATE:__________ ZIP:___________ COUNTRY:________________

Phone #: (__ __ __) __ __ __-__ __ __ __ Alternate Phone: Work/Cell/Foreign: __ __ __ __ __ __ __ __ __ __ __ __

Make/Model:________________________________ Year: 19 _____ Engine:______ DOOR TAG ~ Model: __________

	Part #:	Description:	Qty.	Price:	Total
01)	___-_______	________________________________________	____	$_______	$_______
02)	___-_______	________________________________________	____	$_______	$_______
03)	___-_______	________________________________________	____	$_______	$_______
04)	___-_______	________________________________________	____	$_______	$_______
05)	___-_______	________________________________________	____	$_______	$_______
06)	___-_______	________________________________________	____	$_______	$_______
07)	___-_______	________________________________________	____	$_______	$_______
08)	___-_______	________________________________________	____	$_______	$_______
09)	___-_______	________________________________________	____	$_______	$_______
10)	___-_______	________________________________________	____	$_______	$_______
11)	___-_______	________________________________________	____	$_______	$_______
12)	___-_______	________________________________________	____	$_______	$_______
13)	___-_______	________________________________________	____	$_______	$_______
14)	___-_______	________________________________________	____	$_______	$_______
Subtotal:					$______
Shipping: ESTIMATED(Minimum $15.00 or 12% whichever is more)					$______
Additional Shipping: For HEAVY--OVERSIZE--FOREIGN, to be determined upon shipment:					$_TBD_
California Residents add 7.75% Sales Tax:					$______
:__ __ __ __-__ __ __ __-__ __ __ __-__ __ __ __- *__ __ __				Total:	$______