Ron Lummus Racing  Order Form

Before ordering, please see the How to Order section.

Bold items indicate required fields.

Please print this page for order submission, or download a copy here.

Date: 
Customer Name: 
Street Address: 
City: 
State: 
Country: 
Zip: 
Contact Phone #: 
Fax #: 
E-mail: 
Credit Card #:
Exp Date #:
CVV#

Item Number

Description

Price Ea.

Qty

Ext Price

Total Number of Items Ordered:

Subtotal:

Shipping & Handling:

Credit Card Fee (3%):

California Sales Tax (8.75%):

TOTAL:

Comments: