Diecast Mail-In Order Form
Print Out - Fill Out - Mail In (US Funds Only)

Please PRE-ORDER the following Don Garlits' "Swamp Rat VI" AA/FD(s): (IN STOCK)

Total: ________________

Please PRE-ORDER the following Greer-Black-Prudhomme (1:24 scale) AA/FD(s): (IN STOCK)

Total: ________________

Please send me the following Clear Plastic Display Case for 1/24 scale 1320 diecast dragsters

Total: ________________

______________________________________________

Name: ___________________________________________________________

Company: ________________________________________________________

Shipping Address: __________________________________________________

City: _____________________________________________________________

State: _______________________________________ Zip Code: _____________

Mailing Address (if different): _________________________________________

Phone (Days): ____________________ Phone (Eves): ______________________

e-mail Address: ___________________________________________________

Special Instructions:________________________________________________

Select Payment Type: (include payment with form)

Check Payment Type: _____Cashiers _____ Money Order _____ Certified Check
_____ Personal Check _____ PayPal*
Check Number: __________ (personal checks need to clear our bank before order is shipped)

For Credit Card Payments Diecast: Credit Card Order

Make checks payable to: Left Coast Web Graphics

Mail Order Form To:
Left Coast Web Graphics
AA/FD Diecast Series
210 SW Pine St.
Grants Pass, OR 97526

Phone: 541-955-7130    E-mail: 1320 Diecast

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