Name___________________________
Ship to: ______________________
Company________________________
_______________________
Address_________________________
_______________________
City____________ State_____ Zip_______
_______________________
Phone___________ Fax______________
Quantity
Part
Number
Description
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Shipping:
[ ] STANDARD (Rieken's Racing Picks) [ ] UPS [ ] Fed Ex
[ ] Spee Dee [ ] USPS Priority Mail
[ ] Ground [ ] NEXT DAY [ ]
2ND DAY [ ] 3RD DAY
[ ] International
Credit Card:
Name (as it
appears on card)_____________________________________
[ ]
Discover Card [ ] Master
Card [ ] Visa
Account
#___________________________ Expiration___/___ V-Code____
Signature___________________________ (The V-code is a 3 digit# on
back of the credit card.)
Mail to: RIEKEN'S
RACING
Fax to our 24 hour fax line:
Order
Department
319-377-2139
365 7th Ave.
Marion, IA 52302 USA
SPECIAL INSTRUCTIONS: