Secure Online Order Form
Quantity      Part#                      Description  (Size/Color)       
        
        
        
        
        
        
        
        
        
        
        
        
        

Additional Information:


Billing Information
If paying by credit card, then your billing name should match the name on the credit card and your billing address should match your credit card's billing address.

Billing Name:             
Credit Card Type:       Discover Mastercard Visa
Credit Card Number:      Expiration Date: 
3 Digit V-Code:  The V-Code is the last 3 digits on the reverse of your credit card.  It is located in the signature area.
Billing Address:          
                                   
Billing City:                 
State/Province:           
Zip Code:                    
Country:                      
Billing Phone Number: 


Shipping Information
We offer several forms of shipping for online ordering.  Fed Ex Ground, UPS Ground, Spee Dee or USPS Priority Mail are our standard shipping methods, but we also ship Next Day Air, 2nd Day Air or 3 Day Delivery.  Karts ship via truck.  Please select the shipping method you would prefer. 

Shipping Method:        
Shipping Comments:   

Ship to the Billing Address?:    Yes    No

OR Ship To:
Shipping Name:     
Shipping Address:   
                               
City:                        
State/Province:       
Zip Code:                
Country:                  


Contact Information
This information will only be used to contact you in case we have questions about your order.  You will also be notified by email when we ship your order.  This information is VERY important if your order is time sensitive.  

Contact Name:                 
Email Address:                 

Daytime Phone Number:  


  Thanks for the order.

Web designed & maintained by Rieken's Racing.