312 North Hill Dr. East ST.Paul MB. R2E0H7
204-667-9069 Fax: 204-667-9832
Toll Free 1-866-430-2137
phee@mts.net
Print out and complete order form then mail or fax to: 204-667-9832
(or E-mail to phee@mts.net)
US orders are rebuilt and shipped from within the USA
-----------------------------------------------------------------
Order Form
Contact: __________________________________________________________________________
Company : _______________________________________________________________________
(As appears on Credit Card or Check)
BillingAddress:________________________________________________________________________
(City) (Prov) (Postal Code)
Shipping Address:_____________________________________________________________________
(City) (Prov) (Postal Code)
Phone: ( ) - Fax: ( ) -
E-mail:
Make: Model:
Year:
Pulley Size: (Circle One)
| Problem /Complaint with your Supercharger: |
Shipping Options:
(Check Selection)
UPS Ground: (Free with Purchase)
UPS Blue: (2 Day in
UPS Red: (1 Day in
Payment Options :
Credit Card #: - - - Ex. Date : /
C.O.D. Certified:
Company/Personal Check Mailed: (Ship once payment is received)
Bill Account: &n