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To order please fill out all information so that your order will not be delayed.

Name:

Address:

City, State & Zip

Day Phone:

E-Mail Address:

Make of Car:

Model:

Year:

For wheel orders please fill in information below:

Wheel

Qty.

Price

Total

 

 

 

 

For tire orders please fill in information below:

Tire Model

Qty.

Price

Total

 

Sub Total

 

WA Res add 8.6% Tax

 

Shipping

 

Total Order

Card Type

Card Number

Exp Date

 

 Mastercard

 

 Visa

 

 American Express

 

I certify the above information is correct, furthermore I authorize Auto Styles and Alignment to charge my account for this purchase. (Please note, your order CAN NOT be processed unless this box is checked.)

To pay by check please print form and mail with check for total amount.

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