Choose File - 'Print' to print this form. Or copy it to your disk. Then click 'Back'.

Please fill out this order form.
You may FAX it to us at 973-939-8787 at any time
or call our sales staff 800-526-1096 or 973-334-9575
    Mon-Fri 8:30 to 6:00 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 1-973-939-8787 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
     |                                          |     |       |
     |                                          |     |       |
     |                                          |     |       |
     |                                          |     |       |
     |                                          |     |       |
     |                                          |     |       |
     |                                          |     |       |
     |                                          |     |       |
     |                                          |     |       |
     |                                          |     |       |
     |                                          |     |       |
     |                                          |     |       |
                                            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