Order Form

Name:		Date:
Street:	City:	State: Zip:
Telephone	home	work
E-Mail Address

Orders without phone contact info will not be accepted.

Terms: (circle one) VISA MASTERCARD AMERICAN EXPRESS PREPAYMENT*
* Note- all prepaid orders will be shipped freight collect.
If VISA or Mastercard please complete the following information.
Credit card # Expiration date ( ) / ( )
Name as it appears on the card CVV Code#
Authorized signature

Please complete the following information:

CAR TYPE	BODY STYLE	ENGINE WATER PUMP	ALTERNATOR	COMPRESSOR
Year	Coupe ( )	Long ( )	Driver side ( )	Driver side ( )
Make	Sedan ( )	Short ( )	Pass side ( )	Pass side ( )

Was your car equipped with factory air? yes no

55-57 CHEVY radiator location	COOLING SYSTEM	FREIGHT CHOICE
V8 ( )	Engine driven Fan ( )	Ground ( )
6 Cyl. ( )	Electric fan ( )	3day ( )
		2day ( )
		1day ( )

Terms: (circle one) VISA MASTERCARD AMERICAN EXPRESS PREPAYMENT*
* Note- all prepaid orders will be shipped freight collect.
If VISA or Mastercard please complete the following information.
Credit card # Expiration date
Name as it appears on the card CVV Code#
Authorized signature

QUANTITY	PART NUMBER	DESCRIPTION	PRICE EACH	TOTAL PRICE




		SUB TOTAL
		Freight charges*
		Total

We ship XXX. All merchandise is shipped freight collect. On credit card orders freight charges will be added to your invoice. If paying by check please call for shipping cost quote. All prices are subject to change without notice.

Mail orders to: Australian Auto Air
32 Prospect Street
Mornington VIC 3931

Fax orders to: Australian Auto Air
03 5975 9922