Gas Alley Streetrods - Order Form
We carry all of these
manufactures products plus more!
 If they have it in their catalogs,
we can generally beat their
published pricing, give us a try!
Proud member of
SEMA.  Protecting all
car enthusiasts rights
Gas Alley Streetrods
New Phone#
Phone: 913-244-0112
To Order by Fax or Mail
Complete and fax this form to Pending
Or Mail To: Gas Alley Streetrods, 5133 Mansfield Lane, Shawnee, KS 66203
Or complete and mail, fax or e-mail it to admin@gasalleystreetrods.
Step 1 - Contact Information

Billing Address:
Name_______________________________
Street_______________________________
City_________________________________
State________________________________
Zip/Postal Code______________________
Country_____________________________
Daytime Phone #_____________________
E-mail Address_______________________
Ship To Address, if different (for UPS shipping, a street address is required - UPS will not
deliver to PO boxes)
Name_______________________________
Street_______________________________
City_________________________________
State_______________________________
Zip/Postal Code_______________________
Country_____________________________

Step 2 - Products
Quantity         Item #         Description        Price Each        Item Total
                             
                            
                            
                            
                            
                            
                            
                            
                            
                            
                            
                            
                            
Subtotal         


Step 3- Shipping, Tax, and Payment
Product Subtotal from above _____________________
Shipping Charges (See shipping chart here) _________________
Hawaii, Alaska, and Foreign Orders: Please call 913-244-0112 for a shipping quote.
Orders shipping to Kansas addresses add 6.75% Sales Tax ______________
Total Payment ______________
Payment Method
Visa___ MasterCard___ Discover___ AmEx___ Check or Money Order Enclosed________
Credit Card #________ - __________ - __________ - ___________
Expiration Date__________ / __________

Signature___________________________________________________________

Special Shipping Items (e.g. Completely Assembled Carburetor Setups) require extra
shipping charges.

Orders containing hazardous items can only be shipped via UPS Ground (to the Lower 48
United States)