Please print this form and send along with payment when placing an order by mail.

AutoAccessories4Less
2200 Maiden Lane
St. Joseph, MI. 49085

Ship to:

Name: ___________________________________________

Address: _________________________________________________

_________________________________________________

State:___________ Zip: ___________ Country: ___________

 

 

Bill to: (if different than above)

Name: _____________________________________________

Address: ___________________________________________

_______________________________________________

State: __________ Zip: __________ Country: ___________

 

Method of payment:
(please circle)

Check
Money order
Credit Card/Debit
Wire Transfer

 

 

 

Credit card # (if applicable) __________________________

Exp: _____ / ______

Verification Code: _____

 

 

E-Mail address:______________________________________

 

 

Phone: (_______)_______________________

 
Qty: Part # Description (and color if applicable) Price Total
_____ ___________ _____________________________________________ $_______ $_______
_____ ___________ _____________________________________________ $_______ $_______
_____ ___________ _____________________________________________ $_______ $_______
_____ ___________ _____________________________________________ $_______ $_______

 

Sub total

 

$_______

Sales tax (Michigan only .6%)

 

$_______

*Other

$_______

**Under $99.99 add $13.99 Handling

$_______

Total $ ______

 

Vehicle year ______________________

Vehicle make______________________

Vehicle model _____________________

 

Comments:____________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

*All others please email for a shipping quote and enter your quote amount in the "*Other" box above.

**Free shipping in the contiguous 48 U.S. States. Orders under $99.99 add $13.99 Handling Fee.