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
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Product Total |
$ |
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Indiana Customers Add 6% Sales Tax |
$ |
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Shipping |
$ |
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Grand Total |
$ |
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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.