You may TYPE the required information -or print the page an fill-in manually

Note:  email address or fax number is necessary if you would like an order confirmation.

First name Middle initial Last name  

Company

Mailing address (Shipment by PRIORITY MAIL)

Apt, suite, lot

City State Zip

Country   Email

Telephone--  Fax--  

CommentNote: email or fax is necessary if you would like an order confirmation

 

Money Order enclosed    Cashiers check enclosed    Check enclosed

Choose Credit Card TypeMastercard    Visa

Credit Card        Expires Month/year

 

CVV2... ON BACK of the card- 3 DIGIT CODE ON THE SIGNATURE LINE. Some banks will decline the charge if this is not presented.
Cardholder's name

  Cardholder's zip 

 
Qty Part number Description Price Extension
      Shipping
      Total
Instructions: when the form is completed- proofread for accuracy, then  print the page for your records.
 

Mail to:

Reddy Parts

1190 Salty Bottom Rd

Gurley, Al 35748

 

 Fax to:  866.870.9370