The Classic Preservation Coalition - Printable Order Form

Classic Preservation Coalition
Phone: (518) 374-5078
Email: houghton@classicpreservation.com

Print this order form, fill it out, and mail it to us using the address at the bottom of the page.

ORDER FORM

Date: _________________________

Name: ________________________________________

Address:
(include ZIP/
postal code)

______________________________

Home Phone #:  (        ) _____ - _______

Work Phone #:  (        ) _____ - _______

Fax #:  (        ) _____ - _______

E-mail address (if any):  ________________________________________

Web site (if any):  ________________________________________

Is your vehicle a car or truck?  ________________

Year, make, and model/series of vehicle:  _____________________________________________

# of engine cylinders:  _______

Engine Displacement (cu. in.): _______

Automatic or Standard transmission?  ____________________  If standard, 3 or 4 speed?  _______

Does your vehicle have air conditioning?  __________

Item	Qty.	Description	Cost/Item	Total Cost










			Subtotal:
			NY state residents add 8% sales tax
			Shipping:
			TOTAL ENCLOSED:

Shipping charges for this order will be quoted to you via phone or e-mail.

Make checks or money orders payable to C.P.C.

Credit Card Information

Card name: ____________________
Card Number: ______ ______ ______ ______
Security Code: ______
Expiration Date: ______ / ________

Signature: ________________________________________

THANK YOU

Mail to:

Hal Houghton

CPC

3253 Albany St.

Schenectady, NY 12304

Questions? Go to our Inquiry page, or get in touch with us using one of the options at the top of this page.

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