ORDER FORM
(Minimum Order $20.00; Minimum Shipping $7.95)

TELEPHONE ORDER LINE (800) 459-2122
FAX ORDER LINE (513) 459-7274
TECHNICAL HOTLINE & CUSTOMER SERVICE (513) 459-7374
Hours of Operation 9:00am TO 5:00pm EST Monday-Friday

Premier Motoring Accessories, Inc.
P.O. Box 36
Mason, OH  45040-0036

BILLING ADDRESS
Must be same billing address as credit card.

SHIPPING ADDRESS (No PO Boxes for Shipping)
If Different From Billing Addres

Name:

Name:

Address:

Address:

City:

City:

State:               Zip or Postal Code:

State:                         Zip or Postal Code:

Country: Country:

Fax Number:
When sending a FAX, please provide your FAX number!

 Daytime Phone:            
Email Address:

ITEM#

QTY

PRODUCT NAME

UNIT PRICE

SHIPPING

TOTAL

      
      
      
      
      
      

VEHICLE INFORMATION: __________________________________________________________________________
Please provide year/make/model for vehicle to ensure order accuracy. (Specify Old/New Body Style if applicable.)
SELECT METHOD OF PAYMENT
Credit Card Logos
Check          Money Order       Cashiers Check
Visa  Master Card  American Express  Discover

CARD NUMBER

                               

CARD CVV

       

Signature_______________________________ Exp. Date____/_____ 

Name on Card_________________________________________
                                              (Please Print)