(800)-248-8785 • www.obschevy.com
P.O. Box 68 • Nashville, GA 31639-0068 • (229) 686-5812 • Fax: (229) 686-3056
133
order ForM
Shipping Address: (Print clearly)
Name __________________________________________________
Street __________________________________________________
City__________________________________ State______________
Zip ________________________ Phone _____________________
Date _______________________ Year of Vehicle _______________
Body Style ______________________________________________
Job or Style #____________________________________________
P.O. Box 68 • 524 Hazel Avenue • Nashville, GA 31639
Website: www.obschevy.com
Information Line: (229) 686-5812 • Fax Line: (229) 686-3056
Order Line:
1-800-248-8785
Customer Number ________________________________________
Payment Method:
c Check or Money Order Enclosed c C.O.D. - Payable by Money Order
c MasterCard c Visa c Discover
Card CVC
Number
cccc - cccc - cccc - cccc
Number
ccc
(The Card CVC ID is a 3-digit security code that is printed on the back of your Visa, MasterCard or Discover Card)
Expiration Date _______________ Phone _____________________
Name as it appears on card _________________________________
** Minimum shipping for UPS orders is $12.00 for prepaid orders and $22.00 for C.O.D. if shipped in the continental U.S. Excess shipping will
be refunded. Larger items such as doors, fenders, etc. must be prepaid and will be shipped Truckline. Crating fee for most truckline orders is
$45.00.
SUBTOTAL
** Add 15% for Shipping
Minimum Fee is $12.00
Georgia Residents
Add 7% Sales Tax
TOTAL
NOTE: Back ordered items will be shipped as soon as
possible. If you don’t want items back ordered
or wish to cancel an existing back order, please
notify us.
Qty Group or Part # Product Description Price Each Total
