Supercharger Rebuilder
26988 SE Hwy 19 Unit #47 Old Town, FL 32680
PO Box 186 Old Town, FL 32680
352-542-0147 Fax: 352-542-9468
supercharger@excite.com
Print out and complete order form then mail or fax to: 352-542-9468
(or E-mail to supercharger@excite.com)
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Order Form
Contact:
____________________________________ Company
: ______________________________________
Billing Address:_______________________________________________________________________________
(City)
(State)
(Zip Code) Shipping Addess:_______________________________________________________________________________
(City) (State) (Zip Code)
(City) (State) (Zip Code)
Phone: (
) -
Fax: ( )
- E-mail:
@
Make:
_ Model:
Year:
Problem /Complaint
with your Supercharger:
Part Number:__________________(From Catalog/Internet Pages)
Shipping
Options:
(Check Selection)
(Check Selection)
UPS Ground:
UPS Blue:
(Two Day)
UPS Red:
(Overnight)
(Usually 2 - 3 days Approx $30.)
(2
Day in U.S. - Approx. $60)
(1 Day in U.S. - Approx.
$100)
Payment
Options :
Credit Card #:
-
-
-
Ex. Date
: /
C.O.D. Certified: Company/Personal Check Mailed: ( Ship once payment is received)
Bill Account: (Dealers/Distributors Only) Purchase Order #:
C.O.D. Certified: Company/Personal Check Mailed: ( Ship once payment is received)
Bill Account: (Dealers/Distributors Only) Purchase Order #:
Fax:# / Mailing Address
Fax: 352-542-9468 PO Box. 186
Phone: 352-542-0147 Old Town, FL 32680
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26988 SE Hwy 19 Unit 47
PO Box 186
Old Town, FL 32680
352-542-0147
352-542-9468 (Fax)
