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Inline Tube Order Form 511
15066 Technology Drive
Shelby Twp, MI 48315 Order
586.532.1338 ph
586.532.1339 fax
Date:_____/_____/_______ Customer Order _______ Dealer Order______ Purchase Order Number____________________________
Bill To: Ship To:
Attention: Attention:
Street: Street:
City: State: Zip: City: State: Zip:
Phone: Phone:
Qty Part Number Description Unit Price Total
Manuals Manuals
/ /
Units Units
Sending Sending
/ /
Tanks Tanks
Gas Gas
Notes: Box Size Sub Total
& Zone MI Tax
Ship
INCLUDE ____________ Car Catalog – Truck Catalog – Street Rod Catalog Total
Credit Card#: _____________-_____________-______________-_____________ Expiration :__________/__________ Cvv:___________
Order Line 800. 385. 9452 15066 Technology Dr
Tech Support 586. 532. 1338 Shelby Twp, MI 48315
www.Inlinetube.com
