Hot Heads Fax or Postal Mail Order Form

HOT HEADS Research & Racing, Inc. Printable Order Form

Order by Part Number (P/N) and Description. If you need more space, please continue on a separate sheet of paper.
	Hot Heads Products	Price
P/N 1	Part	Price
P/N 2	Part	Price
P/N 3	Part	Price
P/N 4	Part	Price
P/N 5	Part	Price
P/N 6	Part	Price
P/N 7	Part	Price
Merchandise Total: $ NC Residents Add 7 % Sales Tax: $

Shipping & Handling Costs will be added to your order total.

Please enclose a check or money order for your total or complete the following credit card information (fax or postal mail).I authorize Hot Heads to charge my order total to my (circle one):
MasterCard VISA Discover	Account Number: Security Code	Expiration Date:
Authorized Signature:

Name::

Address:

City/Province

State/Country

Zip or Postal Code

Phone Number

E-mail Address (optional):

Mail your order to: Hot Heads Research & Racing, Inc.
392 Walker's Hollow Trail, Lowgap, NC 27024
or fax to: (336) 352-3892