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Print this
form – MrTailLight.com Mail Order - Checks/Money
Orders (USA Only) Home Page
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·Section 1, Mailing Information
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Customer Name:
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Mailing Address:
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City, State, Zip:
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E-mail and Telephone:
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·Section 2, Item Order Information
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1. Item ID Number:
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Item Price:
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$
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Quantity ordered:
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2. Item Name:
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Item Price:
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$
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Quantity ordered:
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3. Item Name:
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Item Price:
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$
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Quantity ordered:
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4. Item Name:
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Item Price:
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$
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Quantity ordered:
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Subtotal:
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$
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USA Shipping Rates: Please contact
shipping@mrtaillight.com or call us at 1-419-947-6955 to get your shipping total!
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·Section 3, Payment Information
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Total of all items ordered (subtotal):
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$
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Shipping:
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$
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Grand total:
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$
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Make checks or money orders payable to:
MrTailLight.com
P.O. Box 111
Edison, Ohio 43320
Thank you for your order.
If you have any questions about your order, please send an e-mail to sales@mrtaillight.com
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