Please print this form and fax or post to us. Model A Parts Ford parts 1909 - 1948 ORDER FORM Roger Anderson Consign to: PO Box 7213 Taradale, Napier •Ph 06 844 3324 •Mobile 021 448183 •Fax 06 8443590 •Email firstname.lastname@example.org •www.model-a-autoparts.co.nz Phone: Order Mobile: Date: Fax: Delivery Email: Date: Qty Code No Description Price Minimum Courier Charge: $4.00 GST 12.5%: (Payment enclosed) inTotal: AUTHORISED BY: NAME: (print) TERMS AND CONDITIONS: All orders must be pre-paid. Larger items may attract a higher courier charge. Price subject to change without notice. Insurance buyers care if any.
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