Importparts.com Order Form

Importparts.com Order Form

(1) Fill in your order
(2) PRINT

(3) Mail to:
5529 Rosemead Blvd
Temple City, CA 91780

(3) E-mail to:
order@importparts.com
(3) Fax to:
626-286-4458

Billing Address Only

Full Name

Address

City St ZIP

Country

Home No. Work No.

eMail Address

Quantity

Description or Part Number

Unit Price

Total

Subtotal

Shipping

Fill in tax amount only if you reside in California (8.25%) >

Sales Tax

Total

Payment Method

	Check/Money Order
	MasterCard*
	VISA*
	Discover *
	American Express*

Please fill out credit card information completely

Name on Card

CC#

Exp. Date Bank Name

Bank 800 Number

American Express Cards ~ CID number

By signing this order form, I acknowledge that I have read and understand the terms and conditions of sale.
* Please include a copy of your picture ID and credit card


Mail Order Customer Signature	Date