Car Parts Direct
440 Winnebago Ave.
Fairmont, MN 56031
866-554-7278
FaxBack to: 952-486-8108

Fax Order Form

Date______________

 

Billing To:_____________________________________________

Address:_____________________________________________

City, State, Zip:_____________________________________________

Phone#___________________________ Fax #____________________

 

Shipping To:___________________________________________

Address:_____________________________________________

City, State, Zip:_____________________________________________

Phone#___________________________ Fax #____________________

 

Credit Card Type:          VISA    or     MASTERCARD    only

Name on credit card:_________________________________________

Credit Card Number:________________________________________

Expiration Date:__________________

3 Digit Verification Code on back of card _________

 

Vehicle Year:_____________ Model:___________________________

Part Purchased:_____________________________________________

Price Quoted with shipping:_______________ Quote #:_____________

***Engines, Transmissions and axle assemblies need to be shipped to a commercial address***