Mail order form

Use this form to place your order by mail.  Either type in your information and print the form, or print the form and write in your information.  Send it to the address at the bottom of the page.

 

Shipping information

Name   

 

Phone - 
Daytime  - -
Evenings - -

E-mail -

(Please include your e-mail address so we can notify you when your order has been shipped.)

Item Quantity Cost Each Total
SUB TOTAL    
SHIPPING AND HANDLING **    
TOTAL    

 

Fill in your truck information here

   Make  

(If writing your information in, circle the choice(s) below that apply to you.)

   

Transmission - 

Manual Auto       

Special handling instructions - 

Billing Information -

Credit Card info -

Visa     MasterCard     American Express

Card Number - - - -      Expiration Date - /

Name on Card -

Billing Address (if different from shipping address)

Name   

 

OR

Make money orders/checks payable to "Diesel Performance Specialists, Inc."  Orders shipped upon arrival if made with a bank check or money order. Orders made with personal checks (US banks only) may be held until funds clear.

Please mail your order to -

Diesel Performance Specialists, Inc.

P.O. Box 152

Saranac, MI 48881-0152

** For Orders over $500, add $25 shipping.  For orders under $500, add $15.