PWP ORDER FORM

Ordered By:                                                                           Ship To If Different:

__________________________                                      ____________________________
__________________________                                      ____________________________
__________________________                                      ____________________________
Telephone # ________________                                      ____________________________
Truck Model:________________
Year:______________________
 
 
Item # Description Qty Unit Price Total Price
         
         
         
         
         
         
         
         
         
         
         
         
  

Subtotal  
Shipping  
Total  
                           

Shipping  Charges
POSTAL DELIVERY                                                     Make check payable to:
  All parts are plus shipping.                                          Dennis Sherman  PWP
Parts are to be paid for up front,                                   7 Shady Lane
when item arrives send an additional                           Berlin, Ma. 01503
check for the price on the shipping
label