ORDER FORM
DATE: JULY 13, 2017
PLEASE COMPLETE THIS FORM BELOW
AND EMAIL OR FAX IT BACK TO US
Page 1 of 2
2786 Hwy 43 North
Lawrenceburg, TN 38464
Phone 866-762-7527 24 hr Fax 931-829-4627
[email protected]
BILL TO:
SHIP TO ADDRESS: (IF DIFFERENT) NO PO BOXES
[Name]
[Name]
[Company Name]
[Company Name]
[Street Address]
[Street Address]
[City, ST ZIP Code]
[City, ST ZIP Code]
[Phone]
[Phone]
ALTERNATE PHONE [ABC12345]
EMAIL ADDRESS [ABC12345]
SHIPPING METHOD – GROUND, NEXT DAY AIR ……
THESE PARTS ARE FOR YEAR {
QTY
} TYPE OF CAR { PONTIAC
ITEM #
CARD NUMBER {
COMMENTS / INSTRUCTIONS
EMAIL ADDRESS MODEL {
DESCRIPTION
} EXP DATE {
} TRANY {
UNIT PRICE
} 3 OR 4 DIGIT SECURITY CODE {
}
LINE TOTAL
}
SUBTOTAL
SHIPPING
TN RESIDENTS ADD 9.75% SALES TAX
TOTAL
PAYMENT
METHOD
CHECK | BANK TRANSFER | CREDIT CARD | OTHER
PRICES ARE SUBJECT TO CHANGE – WE WILL NOTIFY YOU OF ANY PRICE INCREASES BEFORE PROCESSING YOUR ORDER
ORDER FORM TIPS
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We will email or call to confirm order accuracy, invoice total, and ship date before the
order is processed and charged.
VISA/MC/DISCOVER REQUIRE 16 DIGIT ACCOUNT NUMBERS
AMEX REQUIRE 15 DIGIT ACCOUNT NUMBERS
The card ID / Security code is located on VISA / MC / DISCOVER cards on the back of the
card. Last three numbers
AMEX cards have this code located on the front of the card above account number (4
numbers)
WE ACCEPT CREDIT CARDS, BANK TRANSFER, AND MONEY ORDERS AS FORM OF
PAYMENT.
PERSONAL CHECKS WILL BE HELD UNTIL CLEARED BY THE BANK.
WE SHIP WORLDWIDE, PLEASE LET US KNOW HOW FAST YOU WOULD LIKE
SHIPPING ON YOUR ORDER ONCE IT HAS BEEN FILLED. NEXT DAY AIR – GROUND
ETC… CONTACT US FOR SHIPPING OPTIONS AND CHARGES **For our Canadian
customer’s, Butler Performance is part of the UPS e-Tailer Brokerage Program (eBP) which
where eligible shipments imported into Canada for non-commercial purposes and valued
under (CAD)$200.00 shipped via UPS Standard service are subject to a reduced brokerage
fee of (CAD)$10.00, plus any applicable duties and taxes. Shipments valued at
(CAD)$200.00 and above and/or being imported to Canada for commercial purpose and/or
subject to specialized clearance may incur additional fees. Please, be aware that UPS will
request payment at the time of delivery. You can call UPS @ (1-800-742-5877) to pay for
these charges before delivery.
WE PRIMARIALY SHIP VIA UPS BUT CAN ALSO SHIP USPS. DB SCHENKER AND FEDEX.
PLEASE NO P.O. BOXES UNLESS IF YOU SPECIFY USPS MAIL
PRICES ARE SUBJECT TO CHANGE – WE WILL NOTIFY YOU OF ANY PRICE INCREASES BEFORE
PROCESSING YOUR ORDER
RETURNS MAY BE SUBJECT TO A RE-STOCKING FEE. ALL RETURNS MUST BE PRE-APPROVED
BY BUTLER PERFORMANCE
PLEASE COMPLETE THIS FORM AND EMAIL OR FAX IT BACK TO US