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Please fill out this order form.
You may FAX it to us at 973-334-5423 at any time
or call our sales staff 800-526-1096 or 973-334-9575
Mon-Fri 8:30 to 8:00 Eastern Time
or mail your order.
ORDER FORM KANTER AUTO PRODUCTS Date Ordered ______
76 Monroe St
Boonton NJ 07005 USA
Toll Free Order Line 1-800-526-1096
Info Line 1-973-334-9575 FAX 1-973-334-5423 24 Hour
Your Name ______________________________ e-mail_________________
Street________________________Apt_______
City__________________State___Zip________ Country___________
Phone #_____________________ FAX #_____________________
Vehicle Data: Make______: Year___: Model _________: # Cylinders___:
Engine Size___: # Doors___: Body Style_____________:
Brakes: Drum__: Disc:__: Manual__: Power:__: Delco__: Bendix__:
Steering: Manual__: Power __: 2wd___: 4wd___:
Transmission: Standard__: Automatic__:
Exhaust: Single__: Dual__:
Carburetor: 1BBL__: 2BBL__: 4BBL__:
Holley__: Rochester__: Stromberg__: Carter__: Other_________:
Fuel Pump: Single Action__: Double Action__:
How Price Total
Many Description of Items Each Price
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Sub Total $_______
Add 15% Shipping & Handling ($8.00 min,$60.00 max) _______
Foreign Shipping and outside 48 states see shipping _______
Total _______
I authorize the above amount to be charged to my MC or Visa
credit card #_________________________ valid thru___/___
Signature______________________________
code L315-NT1L