Please print this form for your mail or fax orders! (Not for use on-line)
Click your BACK button to continue when you are finished with this page.
 
The Fiero Store Date:     
 
 
60A Progress Drive · Manchester, CT 06042
fierostore.com · 1-800-343-7648		 Customer Number:   
 
Bill To Ship To
Name:      Name:     
C/O:      C/O:     
Address:      Address:     
City:      City:     
State:    Postal Code:     State:    Postal Code:    
Daytime Phone:      Daytime Phone:     
Email:         
 
Payment Type:   Money Order    Car Info: Year:   
  Check (Please allow extra time for delivery.) Model:   
  Credit Card Engine:   
Card Number:    Trans:   
Expiration Date:     
Cardholder's Signature:   
 Foreign orders please include:
Issuing Bank Name:    Exterior color:   
Bank Phone #:    Interior color:   
For your protection, we thoroughly investigate the validity of all credit card orders.
 
Part # Description Unit Price Quantity Line Price
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Subtotal:   
Toll Free Order Desk:  1-800-343-7648
Customer Service:  1-860-645-1837
U.S. Toll Free Fax:  1-800-882-5769
International Fax:  1-860-645-1845
In CT Add 6.35% Sales Tax:   
Shipping:   
If COD, Add:  $11.00 
TOTAL:   
 
Please view the "Terms and Conditions" on the Order Policy page of our Web Site or page 405 of our printed catalog for detailed information on placing your order. Oversize items ship via truck freight and require extra shipping charge. Please call or visit our website to get the actual shipping charge for your order.