USA Parts Supply
Parts Order Form

Please select the catalog you are ordering from:

1949-1970 Cadillacs 
1971-1985 Cadillacs
1941-1975 Full Size Oldsmobiles 
1961-1975 Oldsmobile F85, Cutlass and 442
1949-1972 Full Size Ford  
1961-1975 Pontiac Tempest, LeMans and GTO 


Vehicle information 

Year:	(required)
Make:	Cadillac Oldsmobile Pontiac Ford Other (required)
Model:	(required)
Body Style	(required)
Trans. type	(May be required)
Power brakes:	Select YES NO
Power Streering:	Select YES NO
Air Conditioning:	Select YES NO

Your information

Name:
Customer # (if known)
Is this a change of address?	NO YES
Address:
City:
State:	- - - - - - - - - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Country:
Email address:	(required)
Phone number:
Additional phone number:
Additional phone number:

Ship to addres: (if different)

Name:
Attn:
Address:
City:
Zip Code:
State:	- - - - - - - - - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Country:
Daytime phone #:

Enter the parts you are ordering

Item#	Office use	Qty	Part no.	Year	Complete Part Description	Price each
1
2
3
4
5
6
7
8
9
10
					SUBTOTAL:
					4.5% VA Sales Tax: (VA shipments only)
					Insurance:
					Shipping Charges: (see chart below)
					C.O.D. Charge: ($8.75)
					TOTAL:

UPS GROUND SHIPPING
Orders up to $25.00	add $7.99
25.01 to $40.00	add $9.49
40.01 to $60.00	add $10.49
60.01 to $75.00	add $11.49
75.01 to $100.00	add $12.99
100.01 to $150.00	add $15.99
150.01 to $200.00	add $19.99
200.01 to $300.00	add $23.99
300.01 to $400.00	add $27.95
400.01 to $500.00	add $31.95
500.01 to $600.00	add $34.95
600.01 to $800.00	add $37.95
800.01 to $1000.00	add $39.95
Over $1000.00	FREE!
Add $5.00 per oversized item

METHOD OF PAYMENT

Visa
Master Card
American Express
Discover
Account Number:
Exp. date:
Cardholder's name:
Check
Money Order
C.O.D.

 Date:   

I have read the Terms & Conditions     

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