2002 Diecast Mail-In Order Form
Print Out - Fill Out - Mail In (US Funds Only)

Please send the following Gary Cochran "Mr C" AA/FD(s): (IN STOCK)

• Send me ______ Diecast Models @ $59.95
• $ ____________ Total Cost of Diecasts Ordered
• $ ____________ Shipping & Handling for each piece ordered ($7.75) -- (Canada $9.75) (Europe-UK $16.00)

Total: ________________

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

• Send me _____  Clear Plastic Display Case @ $17.95
• $ ____________ Total Cost of Cases Ordered
• $ ____________ Shipping & Handling for each piece ordered ($7.75) -- (Canada $9.75) (Europe-UK $20.00)

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)

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

Members Site Map || Visitors Site Map