Walters Motorsports - Race Parts Dealer

Please Print & Fill Out Form and Return with Check or Money Order to the Following Address:

Walters Motorsports
5011 Conger Dr.
St. Louis, MO 63128

Please Allow 1-2 Weeks Delivery Time (Depending on Race Schedule)

NAME:(Please Print)

ADDRESS:

CITY:

STATE:

ZIP:

DAYTIME PHONE:

EVENING PHONE:

EMAIL ADDRESS:

DESCRIPTION	PRICE	QUANTITY	TOTAL
Black or White	$110.00 ea.	__________	__________
Blue, Red, or Yellow	$115.00 ea.	__________	__________

DESCRIPTION	PRICE	QUANTITY	TOTAL
Torque Absorber	$110.50 ea.	__________	__________
Small Replacement Biscuit	$9.00 ea.	__________	__________
Large Replacement Biscuit	$17.00 ea.	__________	__________

(Biscuits are made in the following durometers 70 60 50, Please Note the One in Your Order)

DESCRIPTION	COLOR	PRICE	QUANTITY	TOTAL
Monte Carlo	BLK, WHT	$110.00 ea.	__________	__________
Grand Prix	BLK, WHT	$110.00 ea.	__________	__________
Street Stock	BLK, WHT	$110.00 ea.	__________	__________
Monte Carlo	RED, BLU, YEL	$115.00 ea.	__________	__________
Grand Prix	RED, BLU, YEL	$115.00 ea.	__________	__________
Street Stock	RED, BLU, YEL	$115.00 ea.	__________	__________

DESCRIPTION	PRICE	QUANTITY	TOTAL
		__________	__________
		__________	__________
		__________	__________

DESCRIPTION	PRICE	QUANTITY	TOTAL
Front Bumper	$45	__________	__________

Total Amounts minus 20% or add $15 for single item shipping

__________

WALTERS MOTORSPORTS IS NOT RESPONSIBLE FOR LOST ORDERS OR PARTS. PLEASE SEND ONLY CHECK OR MONEY ORDERS WITH YOUR PRINTED ORDER FORM. THANK YOU FOR YOUR CHOSING CHUBECK AND WALTERS MOTORSPORTS!!!