Wiring Harness Conversion Packing Slip

Name:________________________________________________

Conversion (What engine are you putting into what car): ______________________________________________________

Phone number(s):_______________________________________

Email address:__________________________________________

Return Address:

 

 

 

Method of Payment (check one)

 Money Order Enclosed

 Money Order mailed separately

 Paypal (Paypal address or username:_____________________)

Amount sent: _______________  Paid for Priority Service

How did you hear about us?_______________________________

Notes: