____The Streetrod Manufacturing Co. Inc.____
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____The Streetrod Manufacturing Co. Inc.____
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THE STREETROD MFG CO INC. (303)688-6882 Fax: (303)660-4660 4321 E Willow Creek Rd.# 16 Castle Rock CO 80104-9766 To place an order, fill in all the information requested below. If you have ordered from us before and wish to use the same credit card, you can select that option below. If using a credit card we do not have on file, fax or mail it with the order payment information included or, you may submit the electronic form without payment and call us with your credit card information to complete your order. Thank You. Please note due to the complicated measurements needed on some axles, orders placed through our order forms, may need additional information before they can be completed. Please give us a daytime phone, an e-mail address, or fax number in case more information is needed to fill your order. Thank You. We will not use your phone numbers or addresses for marketing purposes, it is only used for order fulfillment and to aid shipping if there are any errors. BILLING INFORMATION Name as it appears on card _________________________________________________________________ Company Name (if applicable) ______________________________________________________________________________ Billing Address __________________________________________________________________________________________________ City ______________________________________ State or province _________________________________________ Country _______________________________________________ Zip or Postal Code _________________________________________________ Daytime Phone with Area Code _______________________________________________ Evening Phone with Area Code ________________________________________________ E-Mail Address _______________________________________________________ If your email address is blocked for spam, unblock it for our email address or make sure we have another way to contact you. Thanks. SHIPPING INFORMATION (only needed where different from billing information) Ship to address if different than Billing: ___________________________________________________________________________________ Ship to Name ____________________________________________________________________ Ship to Address _________________________________________________________________________ Ship to City ___________________________________________________________________ Ship to State or province __________________________________________________________ Country __________________________________________________ Ship to Zip or Postal Code ___________________________________________________________________ Shipping Phone Number with Area Code ____________________________________________ How did you hear about us? _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ INFORMATION ABOUT THE AXLE YOU ARE BUYING PARTS FOR Year of Axle? __________________________________ Number of Wheel Lugs? _______________________________ Model & Description of Axle? __________________________________________________________________________________________ GIVE COMPLETE ORDERING INFORMATION Quantity Part No. Name of Item Part Prices Per Item
Subtotal _____________________________________________ 2.9% Sales Tax (Colo., Only) ___________________________ U.S. 10% Freight (Approx) _____________________________ Total _______________________________________________ CHECK THE BOX BELOW TO INDICATE THE TYPE OF PAYMENT INCLUDED Check or Money Order Enclosed ____ Charge My Credit Card Listed Below ____ I will phone in my Credit Card information ____ Use My Credit Card Listed On File From previous Order ____ Card No _______________________________________________________________ Three Digit Security Number on back of card_______________________________ Expires______________ Name as it appears on card__________________________ Authorized Signature_____________________________________________________ Your Address for Credit Card Statement_____________________________________________ City__________________________________State__________Zip________________
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For ordering and information call 1-303-688-6882. Send mail to TSM Staff with questions or comments about this web site. WE DO NOT HAVE A SECURE E-MAIL SITE. You can fax, phone, or mail your order to submit new credit card information. Thank You. ALL PRICES SUBJECT TO CHANGE WITHOUT NOTICE.
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