Visor Shade Print and Mail Order Form

Visor Shade Print and Mail Order Form

Print this form, fill out order and mail with payment to the address at the bottom of this form.

Quantity	Visor Shade	Price	Total
		9.95


	Sub-Total
	Shipping		6.00
	IN Residents add 6% Sales Tax
	Grand Total

Options: (Must choose one, Dark Shade will be shipped if not specified)
Dark Shade (maximum sun protection)
Lighter Shade (medium sun protection)

Ship To:

Name:
Address:
City:
State:
Zip:
Telephone:
Total Enclosed $_____________ Check Money-Order

Mail Order Form To:

Auto Technologies

5451 North 300 West

Michigan City, IN 46360