SHIP TO INFO

FIRST NAME
LAST NAME
OR BUSINESS NAME
ACTUAL SHIPPING ADDRESS FOR UPS DELIVERY
P.O. BOX FOR POSTAL DELIVERY
CITY
STATE OR PROVINCE
ZIP OR POSTAL CODE
COUNTRY
E-MAIL ADDRESS
PHONE NUMBER


STOCK NUMBER QUANITY PRICE $
STOCK NUMBER QUANITY PRICE $
STOCK NUMBER QUANITY PRICE $
STOCK NUMBER QUANITY PRICE $



ADD $29.00 FOR SPECIAL WIDTH FENDERS.
ADD $29.00 FOR LIGHT RECESSES.
ADD $29.00 EACH FOR LICENSE RECESSES
ADD $19.00 PER SET FOR MOUNTING TABS

LIST IN THE BOX BELOW ANY OPTIONALS LISTED ABOVE YOU WANT.
MAKE SURE ON SPECIAL WIDTH FENDERS TO LEAVE THE OUSTIDE WIDTH YOU NEED.




SUB TOTAL LESS FREIGHT ----------------------------$

FREIGHT

freight policy
add $15.00 freight for orders under $50.00
add $19.00 freight for orders under $100.00
add $25.00 freight for orders under $150.00
add $30.00 freight for orders under $200.00
add $49.00 freight for orders under $300.00
add $59.00 freight for orders under $400.00.
add $79.00 freight for orders under $500.00
for international freight rates e-mail me at golden@rconnect.com - please leave full address so we can get an accurate freight rate
.
FREIGHT TOTAL ---------------------------------------$

TOTAL ORDER INCLUDING FREIGHT-------------------------$


I WILL PRINT THIS FORM AND MAIL WITH MY CHECK PAYMENT

mail payments to OLDY'S / OLDENKAMP - P.O. BOX 222 - HULL, IOWA 51239.

OR



I PREFER TO PAY VIA PAYPAL
a PAYPAL INVOICE will be sent to you via e-mail from which you can make your payment via credit card, allow 24 hours for invoice to be sent.
FOR MORE INFO ABOUT THE MAKING SECURE CREDIT CARD PAYMENTS ON LINE PLEASE VISIT http://www.paypal.com

OR

SEND CREDIT CARD PAYMENT.

VISA

MASTERCARD

DISCOVER

NAME AS IT APREARS ON THE CARD
ADDRESS SAME AS BILLING ADDRESS
CITY STATE OR PROVINCE COUNTRY
ZIP OR POSTAL CODE
CREDIT CARD NUMBER EXP DATE
3 DIGIT SECURITY CODE ON CARD BACK

I have questions and prefer to phone my order in - call 1-712-439-2787 evenings or 1-712-439-3301 day time