1. Type/Fill in the form. 2. Print the form below. 3. Send the completed form to:
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Vanek Custom
10 Thetford Drive
Bella Vista AR 72715
| Payment Method: | SHIP TO: | |
| Type of card: | Name: | |
| Card number: - - - | Street Address: | |
| Card expiration date: / | City, State, Zip: | |
| Name on credit card: | Phone: - - | |
| Qty: | Model: | Item: | Cost: | Total: |
| Shipping | ||||
| 7% AR Tax | ||||
| TOTAL |
$5.00 Shipping on all parts add $3.00 for insurance.