Order Form
PRINT &
Mail To
GMCPaul's Truck Parts
505 Adams Drive,
Rockville, IN
47872
Phone-(765)569-2906  Fax-(773)442-0103
 
*Indicates a REQUIRED FIELD  
Billing Information
*First Name:_______________________*Last Name:___________________________ 

Company:___________________________

 *Address1:_______________________________ *City:_________________________

  *State/Province/County:_____________________________

 *Postcode/Zip:_______________ *Country:_______________________
   
*Day Phone:___________________ Home Phone:__________________ 

 Fax:_________________________ *Email:____________________________________________        

VEHICLE INFO: Year_______ Circle Make- Chevrolet or GMC  Model- 1/2,3/4,1 Ton
 
Circle Wheelbase- Long or Short
  
Circle Bed Style- Stepside(Fenderside), Fleetside(Wideside), Blazer, Jimmy, Suburban, Panel
Where did you hear about us?                          
Ship To Information
Please LEAVE BLANK unless different from address above.
      Ship To Name: 
      Ship To Address1: 
      Address2: 
      City: 
      State: 
      Postcode/Zip: 
      Country:   United States
Circle Payment Form-    Personal Check      Money Order/Cashiers Check      Credit Card 
         
     Credit Card Payment Information
      Name on Card: 
      Circle Card Type:  Visa Mastercard
      Card Number: 
      Expire Date: Month:  01 02 03 04 05 06 07 08 09 10 11 12 Year:  00 01 02 
        03 04 05 06 07 08
 

Product Information

Qty Description Total
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
 

Product Total

$
 

Indiana Customers Add 6% Sales Tax

$
 

Shipping

$
 

Grand Total

$
For HEAVY or OVERSIZE Parts Call or Email for Shipping Cost. For smaller
parts, Use Chart Below.

MINIMUM Shipping $9.00 
Parts Total-$20.00 or less= $9.00 
$20.01-$50.00= $12.75 
$50.01-$100.00= $16.75 
$100.01-$150.00= $20.80 
$150.01-$250.00= $24.75 
$250.01-$300.00= $31.00 
$301.01-$500.00= $37.00 
Please note: SHIPPING IS TO STREET ADDRESSES ONLY NO PO BOXES!! Please allow 
4-10 days for shipping, once payment is received. Indiana customers need to add 
6% for sales tax. Money order, cashiers check and pay-pal,& credit card orders are 
shipped immediately upon receipt, personal checks can delay shipping up to 2 
weeks until the check clears your bank.
 
Comments/Questions/Special Delivery Information
       
 I authorize GMCPAULS Truck Parts to charge my credit card account for the
 above total  I further affirm that the name and personal 
 information provided on this form are true and correct. 
 I further declare that I have read, understand and accept GMCPAULS Truck 
 Part's business terms as published on the web site.