Bench Racing Diecast Order Form

BENCH RACING DIECAST

ONLINE ORDER FORM:

DISCOVER.GIF (1839 bytes)

Fill out the form with your choices and click Send
You will receive an email confirmation of total.
Your card will not be charged until items are shipped!

(if you need more than 12 lines.. simply submit a new form..
we will combine them for you!

Your name:

Street Address:

City:

State:

Zip:

Country:

Phone:

Auction Number: If Any

Item1 number & Name:

Quantity1:

Price1:

Item2 number & Name:

Quantity2:

Price2:

Item3 number & Name:

Quantity3:

Price3:

Item4 number & Name:

Quantity4:

Price4:

Item5 number & Name:

Quantity5:

Price5:

Item6 number & Name:

Quantity6:

Price6;

Item7 number & Name:

Quantity7:

Price7:

Item8 number & Name;

Quantity8:

Price8:

Item9 number & Name:

Quantity9;

Price9:

Item10 number & Name:

Quantity10:

Price10:

Sub Total:

Grand Total:

FOR THE FORM TO SECURELY
ACCEPT YOUR CARD NUMBER,
PLEASE DO NOT REMOVE THE LETTER CODE IN THE BOX!
THANK YOU.

YOUR Number:

Expiration number:

E-mail address:

Comments:

If you prefer not to online submit..

Please Follow These Instructions!

Print off this page & Fill it out... Then
Fax or Mail it... or Copy it and Paste into an Email, then fill it out & send it!
When done.. Then Either:
Fax (315-597-6892) or
Snail mail us your order, (BENCH RACING DIECAST - KEITH STELL
, PO BOX 252, PALMYRA, NY 14522; or
Email the completed form to Keith@sexybloomers.com
We will accept your Phone orders: (315) 597-5330 Any Time
Between 8 am - 10 pm EST. Monday - Sunday (no collect calls please!)
Questions? Keith@sexybloomers.com
Store: (315) 331-7843
We ship only via USPS Priority Mail with Delivery Confirmation.
If you wish to pick up your order, Please call ahead.
We do accept Money Orders, payable to Keith Stell.
Sorry, we do not accept personal checks.
You can request your Money Orders Online from Western Union :
http://www.moneyzap.com

BENCH RACING DIECAST
P.O. Box 252 - 4496 South Creek Road
Palmyra, New York 14522
(315) 331-7843 Store
(315) 597-5330
Fax: (315) 597-6892
Email: Keith@sexybloomers.com

YOUR MAILING ADDRESS:

Name: __________________________________________

Address: ________________________________________

City: ______________________ State: _____ Zip: _______

Telephone: _________________ Fax: _________________

Email:__________________________________________

USPS SHIPPING ADDRESS (Required)

Name: __________________________________________

Address: ________________________________________

City: _____________________ State: _______ Zip: ______

GIFT CERTIFICATES! ______ check here!
Also use this form below

GIFTEE:

NAME: _________________________________________________

ADDRESS: ______________________________________________

UPS STREET:_____________________________________________

CITY: _____________________ STATE:__________ ZIP: ________

GIVER: __________________________________________________

ADDRESS: _______________________________________________

CITY: _____________________ STATE: __________ ZIP: _________

PHONE: ___________________ Email: ________________________

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Date Received:____________

DELIVERY:

We ship USPS priority mail throughout the usa!

Shipping is FREE in USA!

Thank You for Your Order!

Return Policy

(1) 20% Restocking charge on orders that are refused unless defective.

(2) Shipping and Handling are non refundable

(3) Item will be replaced or refunded only if defective

   Catalog No.    Item                          Quantity     Price

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3. ___________    _____________________________  _______   _________

4. ___________    _____________________________  _______   _________

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8. ___________    _____________________________  _______   _________

9. ___________    _____________________________  _______   _________

10.___________    _____________________________  _______   _________

Add lines as you need them

Bench Racing Diecast
P.O. Box 252 | 4496 South Creek Road
Palmyra, New York 14522
Telephone: (315) 597-5330 / (315) 331-7843
Fax: (315) 597-6892