Putzke's FAHRSPASS Order Form

Please fill out as complete as possible to avoid mix-ups!

First Name………………………….Last Name……………………………...

Address………………………………………………………………………..

City…………………………………Zip-Code……………………………….

Phone……………………………….E-mail………………………………….

Type of car…………………………………………….Year…………………

Model………………………………..Chassis #..........................Jule-Frame yes/no

I would like to order:

Part#................................Description………………………………..Quantity…………/$..............

Part#................................Description………………………………..Quantity…………/$..............

Part#................................Description………………………………..Quantity…………/$..............

Part#................................Description………………………………..Quantity…………/$..............

Part#................................Description………………………………..Quantity…………/$..............

Part#................................Description………………………………..Quantity…………/$..............

Part#................................Description………………………………..Quantity…………/$..............

Part#................................Description………………………………..Quantity…………/$..............

Total amount                                                                                                                       $
                                                                                                                                             =======

To above ‘Total amount”: Please add $ 35 for parcel post shipping within the US.................$35.00
(For shipping cost outside the US, please contact Putzke’s FAHRSPASS).

Grand Total                                                                                                                     $
                                                                                                                                             =======

Print and fax to: 858 486 3870 or e-mail to putzkes@cox.net . Unfortunately, we don’t accept credit cards. Please send check or money order to: Putzke’s FAHRSPASS, 13809 Eisenhower Ave., Poway, CA 92064. After receiving your payment, please allow 5 days to fill your order.                                       
Thanks for your business!