Real Gaskets Tennessee
2506 Stateline Road
Elizabethton, TN 37643 U.S.A.
Phone: 800-635-7325

Phone: (423) 543-6194
FAX: (423) 543-9772
Email:

RETAIL ORDER FORM


Ship To:
Name:
arrow
as it appears
on credit card
      Address:
City:   State:
Zip Code:   Country:
Telephone:   Email:
 
(Please include country code)
  Purchase Order:
       
Bill To Address (if different than above):
Address:      

Part Number:
Qty.
Price
Total
$ ea.
$
$ ea.
$
$ ea.
$
$ ea.
$
$ ea.
$
TOTAL (SHIPPING NOT INCLUDED)    
$

SHIPMENT METHOD:


Purchases $15.00 and under will be sent via First Class US Mail.

Orders exceeding $15.00 will be shipped by Priority Mail or UPS for tracking purposes. Please select a shipping preference:

Priority Mail     UPS     Most Economical

Note: Shipping charges will automatically be added to all orders.


Credit Card Number AND Purchase Order Number (if applicable):   
(Visa, Mastercard or Discover ONLY - we do not accept American Express)

CVV Number:
(3 Digit Code on back of credit card)

Expiration Date:  


THANK YOU FOR YOUR ORDER!!   Back to the HOME PAGE.