Top End Performance - Top-End Performance International Fax Order Form

Top-End Performance International Fax Order Form
Print Out This Order Form, Complete It, And Then Fax It To: 818 764-0155 (Please Print Clearly) We also require the Credit Card Security (Sec.) Code. This is the string of Numbers on the back of the card where you sign your name. Be sure and include the Country and City codes when entering the Fax and Phone numbers. We can ONLY ship to the verifiable Billing address for the credit card. No exceptions. Many International Cards are restricted with purchase limits for mail order sales. We recommend you contact you bank before placing the order to insure that your card will be valid for the purchase. Cardholder acknowledges the amount shown of this purchase and agrees to perform the obligations set forth by the cardmembers agreement with the issuer. The charge will appear on your statement as Top-End Performance. The cardholder also agrees that by signing this form and having the parts sent to an address other than the billing address that the cardholder gives up the right to a chargeback of this sale amount or claiming that this order was placed without the cardholders approval.

Name On Card:
Business Name:
Vehicle Make,Model,Year:
Address:
City and Postal Codes:
Country and Province:
Phone Number:
Fax Number:
E-Mail Address:
Payment Method:	Visa or Mastercard (Circle One )
Shipping Method:	Global Express Mail UPS Fed-Ex ( Circle One )
Credit Card Number:	- - -
Expiration Date and Sec.code:
*Cardholder Signature:*
*Print Cardholder Name :*

Quantity	Complete Item Description	Unit Cost	Extension








SHIPPING & HANDLING CHARGES Upon receipt of your order we will we will fax or e-mail you back with a confirmation, shipping total and the status of all items on your order, and expected ship date.		Parts Total:	$