ORDER FORM
MANTIQUES RESTORATION SERVICES
SPECIALIZING IN MODEL A PARTS, MAINTENANCE AND REPAIRS
HIT AND MISS ENGINES AND BELT DRIVEN MACHINERY
CUSTOMER:
DATE:
ADDRESS:
EMAIL ADDRESS : PHONE:
ITEM QTY
PART NO
DESCRIPTION
PRICE
TOTALS
           
1
         
           
2
         
           
3
         
           
4
         
           
5
         
           
6
         
           
7
         
           
8
         
           
9
         
           
10
         
       
SUB TOTAL
 
           
     
EMAIL wildcad@comporium.net FOR SHIPPING CHARGES
SHIPPING
 
     
or
   
     
MAIL TO 1067 SHERATON WAY, ROCK HILL, SC 29732
TOTAL
 
           
     
THANK YOU FOR DOING BUSINESS WITH US