ANDERSON MOTORS' PRO SHOP ORDER FORM

Print This Form and Fax or Mail your order
order date:I___________________
SHIP TO
BILL TO (If different)
Name:I___________________ Name:I___________________
Address:I___________________ Address:I___________________
City:I___________________ City:I___________________
State:I___________________ State:I___________________
ZIP:I___________________ ZIP:I___________________
Phone:I___________________ Phone:I___________________
E-Mail:I___________________ E-Mail:I___________________
ITEM NUMBER
DESCRIPTION / COLOR
SIZE
QTY
PRICE
EXT AMT
IV09623*
Canvas Cap (autocar logo)*
NA*
2*
8.95*
17.90 *
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I* Example * *Shipping & Handling Charges: Total Price: I
I (Up to $25.00) = $4.95 Sales Tax I
I ($25 to $50) = $7.95 S& H** I
I ($50 to $100) = $10.00 I
I (Over $100.00) = Call Grand Total I
Method of Payment: Check______ Visa:_____ MC:_____ AMEX:_____
Credit Card Acc't Number:___________________________________ Exp Date:____________
Cardholder's Signature:______________________________________
    Mail Order To:
    Anderson Motors, Inc.
    170 Amaral Street
    East Providence, RI 02915-2223

    or Fax Order To:
    (401)431-2623