Order Form

AMK Products Inc. Fax or Mail Print Order Form

Ship To: Bill To:

Name		Name
Street		Street
City		City
State/Zip		State/Zip
Phone		Phone

ALL information MUST be completed or your will NOT be processed.

Car Info: Year ______ Model _________ Body Style _________ Engine _________ Trans ________

Interior _______ Generator __ Alternator __ PS __ AC __ Drum Brakes __ Disc Brakes __ Smog __

Qty	Part #	Page #	Description	Price	Total









AMK Products, Inc. 800 Airport Road, Dept. E Winchester, VA 22602			$30 MIN (1st order includes a catalog, additional are $6) Sub-Total
			*Shipping 5% ($8.00 Min.)**
			COD $9 per package
			Sales Tax (VA only) 5%
			Insurance .40 per $100**
			Total

Visa MC Check Money Order COD Email address

Card # - - - Expires Signature

* Heavy Items, Export or Expedite cost extra ** First $100 shipped via UPS already insured

phone 540-662-7820 Fax 800-518-2871