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The Fiero Store Date:     
 
 
60A Progress Drive · Manchester, CT 06042
fierostore.com · 1-800-343-7648		 Customer Number:   
 
Bill To Ship To
Name:      Name:     
C/O:      C/O:     
Address:      Address:     
City:      City:     
State:    Postal Code:     State:    Postal Code:    
Daytime Phone:      Daytime Phone:     
Email:         
 
Payment Type:   Money Order    Car Info: Year:   
  Check (Please allow extra time for delivery.) Model:   
  Credit Card Engine:   
Card Number:    Trans:   
Expiration Date:     
Cardholder's Signature:   
 Foreign orders please include:
Issuing Bank Name:    Exterior color:   
Bank Phone #:    Interior color:   
For your protection, we thoroughly investigate the validity of all credit card orders.
 
Part # Description Unit Price Quantity Line Price
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
Subtotal:   
Toll Free Order Desk:  1-800-343-7648
Customer Service:  1-860-645-1837
U.S. Toll Free Fax:  1-800-882-5769
International Fax:  1-860-645-1845
CT, FL, GA, MI, or PA Sales Tax:   
Shipping:   
TOTAL:   
 
Please view the "Terms and Conditions" on the Order Policy page of our Web Site for detailed information about placing an order. Oversize items ship via truck freight and require an additional shipping charge. Please call or visit our website to get the actual shipping charge for your order, or to inquire about sales tax rates in CT, FL, GA, MI, and PA.