Putzke’s FAHRSPASS  -  Order Form

Please fill out as complete as possible to avoid mix-ups!

First Name………………………………………………………..Last Name………………………………………………………..

Address………………………………………………………………………………………………………………………………………..

City…………………………………………………………………..Zip-Code…………………………………………………………..

Phone……………………………………………………………….E-mail………………………………………………………………

Type of car……………………………………………………….Year…………………………………………………………………

Model…………………………………………...Chassis #..............................................Jule-Frame yes / no

I would like to order:

Part #...............................description………………………………………………..Quantity……../US$...............

Part #...............................description………………………………………………..Quantity……../US$...............

Part #...............................description………………………………………………..Quantity……../US$...............

Part #...............................description………………………………………………..Quantity……../US$...............

(California residents please add 8% sales TAX)………………………………………………………/US$...............

Total amount (exclusive shipping)                                                                                          /US$..............................

Shipping for one of our conversion kits parcel to the lower 48 States is US$ 49.
For shipping to Alaska, Hawaii or outside the USA, please contact Putzke’s FAHRSPASS for detailed information.

Unfortunately, we don’t accept credit cards; PayPal on request.
Please send check or money order to: Putzke’s FAHRSPASS, 948 8th Street, Ramona, CA 92065.

After receiving payment, please allow 5 days to fill your order.
Thanks for your business!