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The Fiero Store

ORDER FORM
ORDER DESK :
1-800-FIERO-GT
 TECH LINE :
(860) 684-6762
 U.S. Toll Free FAX:
1-800-882-5769
PO Box 538
24 West St.
Stafford Springs, CT 06076

INTERNATIONAL FAX: (860) 684-6785
TO ENSURE PROMPT DELIVERY, PLEASE TYPE OR PRINT CLEARLY

SHIP TO:
 BILL TO:
CUSTOMER #:
 CREDIT CARD ORDERS ONLY
NAME:
 NAME ON CARD:
C/O:
 ADDRESS:
ADDRESS:
 CITY:
CITY:
 STATE:ZIP:
STATE:ZIP:
 CONTACT PHONE: ()
DAY PHONE: ()
 Trans Type:AUTO 4-Spd 5-Spd
HOME PHONE: ()
 YEAR/MODEL/ENGINE SIZE:


QTY
 PART #
 DESCRIPTION
 UNIT PRICE
 PRICE
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $

CARD #:
 Number Box
Expitration Date:
 //
Card Holder Signature
 Shipping
 $
Foreign Orders Only
 If COD
 $10.00
Bank Issuing Card: CT Res. add 6%
 $
Issuing Bank Telephone Number: Total Due
 $


FOR YOUR PROTECTION, WE THOROUGHLY INVESTIGATE THE VALIDITY OF ALL CREDIT CARD ORDERS!
If paying by check please allow extra time for delivery!
Please view the "Terms and Conditions" on the Order Policy page of our Web Site or page 2 of our printed catalog.