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TOYOTA / LEXUS ORIGINAL PARTS ORDER FORM

 

CUSTOMER INFORMATION

E-Mail

Name

 

Tel #

Address

Must be same as billing address

Unit

City

 

Zip

SHIP BY

 

 

 

CARD INFORMATION

 

Card #

 

Expires

CC Tel #

Customer service 800 # at back of the card

Card Type

 

VEHICLE INFORMATION

 

Model

 

YEAR

VIN #

 

Prod. Date

 

Quantity

Part Number

Description

Unit

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List Price

 

Less:  25% DISCOUNT

You Save

 

Add:    Shipping Charges

Freight

 

TOTAL CHARGE TO CARD

 

 

Signature:

 

Date:

 

 NOTICE: You are responsible for the accuracy of your order.  Please double check all Part numbers (supplied by you), to avoid ordering and delivery of wrong parts.  Parts Ordered are not returnable.  We double check all part numbers before shipment.  This is a Special Order covered by our Terms and Conditions.

  Thank You