| MAXIM
RACING, INC.
2709 E. Ash St., Springfield, IL 62703 Phone:(217) 544-7015 Fax: (217) 544-7068 racemaxim@aol.com |
Please print this page from your
web browser and fill in as you search the Maxim product pages
(order will be processed when payment
is received by regular mail or faxed in with credit card information).
Shop online with PayPal also available.
| Customer Name___________________________________________________Date:________ | |||
| Mailing Address_______________________________________________________________ | |||
| E-mail Address________________________________________________________________ Phone___________________________________ | |||
| Item Description | Item Price | Qty.Ord | Amt.Due |
| _______________________________________ | _____________ | _____________ | _____________ |
| _______________________________________ | _____________ | _____________ | _____________ |
| _______________________________________ | _____________ | _____________ | _____________ |
| _______________________________________ | _____________ | _____________ | _____________ |
| _______________________________________ | _____________ | _____________ | _____________ |
| _______________________________________ | _____________ | _____________ | _____________ |
| _______________________________________ | _____________ | _____________ | _____________ |
| Sub-Total | _____________ | ||
| IL Sales Tax 7.75% of sub-total | _____________ | ||
| Postage (to be determined at time of delivery) | _____________ | ||
| Total Amount Enclosed | _____________ | ||
| Substitutions/Special
Instructions/Comments:
_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ |
|||
| Credit Card #_____________________________________
(Master Card, Visa, Discover) |
Exp Date:
_____________ |
Name on Card:
____________________ |
|
© 2005 Maxim Racing, Inc.