Big Jim's Order Form

Orders Only Toll Free 10-5 Central Time Weekdays 1-800-874-6240
Have Page #, Part #, and Description Ready

DATE
NAME
SHIPPING ADDRESS

PHONE
AUTOMOBILE INFO Year Make
Model
Qty. Description Color Price Ea. Total
         
         
         
         
         
         
         
         
Texas Res. add 6.75% Tax

MINIMUM SHIPPING IS $10.00, IF ORDER IS LESS THAN $50.00, IF ORDER IS OVER $50.00, SHIPPING IS 20% OF TOTAL PARTS. LARGE BOXES MAY BE MORE. CALL FOR CORRECT SHIPPING PRICE. INTERNATIONAL, HAWAII AND ALASKA ORDERS MUST CONTACT FOR SHIPPING PRICE BEFORE PLACING ORDER.

Merchandise Total


Total

$
 
$
Circle One
Visa - American Express
Discover  - Master Card

Card Holder Signature

Card Holder Name (Please Print)

Card Number

Expiration Date