The Classic Preservation Coalition - Printable Order Form

Classic Preservation Coalition
Phone: (518) 674-2445
Fax: (518) 674-3732
Email: houghton@classicpreservation.com

Print this order form, fill it out, and mail it to us using the address at the bottom of the page.

ORDER FORM

Date: _________________________

Name: ________________________________________

Address:
(include ZIP/
postal code)

______________________________

Home Phone #:  (        ) _____ - _______

Work Phone #:  (        ) _____ - _______

Fax #:  (        ) _____ - _______

E-mail address (if any):  ________________________________________

Web site (if any):  ________________________________________

Is your vehicle a car or truck?  ________________

Year, make, and model/series of vehicle:  _____________________________________________

# of engine cylinders:  _______

Engine Displacement (cu. in.): _______

Automatic or Standard transmission?  ____________________  If standard, 3 or 4 speed?  _______

Does your vehicle have air conditioning?  __________

Item	Qty.	Description	Cost/Item	Total Cost










			Subtotal:
			NY state residents add 8% sales tax
			Shipping:
			TOTAL ENCLOSED:

Shipping charges for this order will be quoted to you via phone or e-mail.

Make checks or money orders payable to C.P.C.

Credit Card Information

Card name (MasterCard & Visa only): ____________________
Card Number: ______ ______ ______ ______
Expiration Date: ______ / ________

Signature: ________________________________________

THANK YOU

Mail to:

Classic Preservation Coalition

P.O. Box 262

Sand Lake, NY 12153-0262

Questions? Go to our Inquiry page, or get in touch with us using one of the options at the top of this page.

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