Westwood Auto and Truck Parts
Westwood: the Astrodome of Auto Parts Since 1977
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ORDER FORM:
Thank you for your order. FAX ORDERS ONLY. No phone orders. No COD's.
A CLEAR COPY OF YOUR CARD AND YOUR DRIVERS LICENCE MUST ALSO BE FAXED WITH THIS
COMPLETED ORDER FORM.

Please complete this form, print it, and fax it to 419-535-6085.
Order Form
Card Holder Information
Name
Address
City / State / Zip
If Ohio: County
Phone Fax
Email Address
#

Expires
V-Code (from back of Card) #
ALL QUOTES ARE QUOTED AS SHIPPED TO A BUSINESS
RESIDENTIAL DELIVERY WILL BE ADDITIONAL!
UPS ground $5.00, Trucking $75.00
PART REQUESTED:   
Year Make / Model
Part Type
Side (if needed)
Quoted for $ Plus Freight $ Included Freight $
SHIP TO ADDRESS: (if different than mailing address)
Business Name
Attention
Address
City / State / Zip
If Ohio: County
I authorize Westwood to charge the above part on my Credit Card
Signature x_____________________________________ Date
A signature is required for the processing of this Order Form