Parts Order Form

Parts Order Form
568 NY-166 • Cooperstown, NY 13326 • Phone/Fax: 607-286-7322
Text 607-383-0772 • www.wahltowahlauto.com • sales@wtwap.net
Date

YearMonthDay
Date of Quote/Work Order/Invoice
Quote, Work Order, or Invoice #
See original email attachment for quote/WO/Invoice#
BILLING INFORMATION
Company/Business Name
Customer Name*

First NameLast Name
Address*

Street Address

Street Address Line 2, (Apartment, Suite, etc.)

CityState / Province

Postal / Zip Code
Phone Number*
Fax Number
Cell/Mobile Phone
Email*
example@example.com
Ship to Billing Address*

SHIPPING INFORMATION

If different from billing, otherwise, leave blank.
Company/Business Name
Customer Name

First NameLast Name
Shipping Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Fax Number
Email
example@example.com

VEHICLE INFORMATION
VIN Number*
*Your vehicle, or the vehicle the parts will be going on. While we don't require your VIN number for every order, if you are unable to provide this, we will be unable to verify or guarantee fitment of our parts to your vehicle.
Year*
Make*
Model*
PARTS ORDERED
Part 1
Part 1 Price
Part 1 Extended Warranty
https://www.wahltowahlauto.com/warranty
Part 1 Extended Warranty Price
Call use for more warranty information.
Part 2
Part 2 Price
Part 2 Extended Warranty
Part 2 Extended Warranty Price
Call use for more warranty information.
Part 3
Part 3 Price
Part 3 Extended Warranty
Part 3 Extended Warranty Price
Call use for more warranty information.
Part 4
Part 4 Price
Part 4 Extended Warranty
Part 4 Extended Warranty Price
Call use for more warranty information.
Part 5
Part 5 Price
Part 5 Extended Warranty
Part 5 Extended Warranty Price
Call use for more warranty information.
6-Month Parts
TOTAL CHARGES

Please make sure all fields are completed below.
Are You New York Tax Exempt?

Yes (I am out of state, or will provide my Tax ID/EIN)No (I will pay NY Sales Tax)
Tax ID/EIN
(If tax exempt)
Parts & Labor
Subtotal
Core Charges*
If there are no core charges, put zero in this box.
Extended Warranties
https://www.wahltowahlauto.com/warranty
Shipping & Handling*
If there is no shipping, put zero in this box.
New York State Sales Tax*
8% unless tax exempt or out of state.
Total Due*
For confirmation, please retype this total in the "Confirm Total" field.
Confirm Total*

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USDI authorize Wahl to Wahl Auto to charge this amount.

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Name On Card
Exactly as printed.
Billing Zip Code
First five digits only.
Purchase Order
(If Applicable)
Print Name*
Authorized Signature*

Clear
Notes
Please type any additional notes and/or special requests.
***BODY PARTS & WIRING HARNESSES ARE SOLD AS IS, WITHOUT RETURN***
*PLEASE NOTE THAT WE CAN ONLY FREIGHT TO BUSINESSES WITH A WAY TO UNLOAD!*

Should be Empty:

BILLING INFORMATION

SHIPPING INFORMATION

VEHICLE INFORMATION

PARTS ORDERED

TOTAL CHARGES