Bench Racing Diecast Order Form

ONLINE ORDER FORM:

Fill out the form with your choices and click Send
You will receive an email confirmation of total.
Your card will not be charged until items are shipped!

(if you need more than 10 lines.. simply submit a new form..
we will combine them for you!

Your name:

Street Address:

City:

State:

Zip:

Country:

Phone:

Item1 number & Name:

Quantity1:

Price1:

Item2 number & Name:

Quantity2:

Price2:

Item3 number & Name:

Quantity3:

Price3:

Item4 number & Name:

Quantity4:

Price4:

Item5 number & Name:

Quantity5:

Price5:

Item6 number & Name:

Quantity6:

Price6;

Item7 number & Name:

Quantity7:

Price7:

Item8 number & Name;

Quantity8:

Price8:

Item9 number & Name:

Quantity9;

Price9:

Item10 number & Name:

Quantity10:

Price10:

Sub Total:

Grand Total:

FOR THE FORM TO SECURELY
ACCEPT YOUR CARD NUMBER,
PLEASE DO NOT REMOVE THE LETTER CODE IN THE BOX!
THANK YOU.

YOUR Number:

Expiration number:

E-mail address:

Comments:

If you prefer not to online submit..

Please Follow These Instructions!

Print off this page & Fill it out... Then
Mail it... or Copy it and Paste into an Email, then fill it out & send it!
When done.. you can either:
Snail mail us your order, to
BENCH RACING DIECAST
833 West Union Street
The Street Of Shops
Newark, NY 14513.
or Email the completed form to keith@sexybloomers.com
We will accept your Phone orders: (315) 331-7843 Any Time
Between Noon - 6 pm EST. Tuesday - Friday and Saturday 10am - 2pm (no collect calls please!)
Questions? keith@sexybloomers.com
Store: (315) 331-7843
We ship only via USPS Priority Mail.
If you wish to pick up your order, Please call ahead.
We do accept Postal Money Orders, payable to Bench Racing Diecast.
Sorry, we do not accept personal checks.

BENCH RACING DIECAST
833 West Union Street
The Street Of Shops
Newark, New York 14513
(315) 331-7843 Store
Email: Keith@sexybloomers.com

YOUR MAILING ADDRESS:

Name:__________________________________________

Address:________________________________________

City: ______________________ State: _____

Zip: _______

Telephone: _________________

Email:__________________________________________

USPS SHIPPING ADDRESS (Required)

Name:__________________________________________

Address:________________________________________

City: _____________________ State: _______

Zip: ______

GIFT CERTIFICATES! ______ check here!
Also use this form below

GIFTEE:

NAME: _________________________________________________

ADDRESS: ______________________________________________

CITY: _____________________ STATE:__________ ZIP: ________

PHONE: ___________________ Email: ________________________

GIVER: __________________________________________________

ADDRESS: _______________________________________________

CITY: _____________________ STATE: __________ ZIP: _________

PHONE: ___________________ Email: ________________________

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Date Received:____________

DELIVERY:

We ship USPS priority mail throughout the United States.

Thank You for Your Order!

Return Policy

(1) 20% Restocking charge on orders that are refused unless defective.

(2) Shipping and Handling are non refundable

(3) Item will be replaced only if defective

   Catalog No.    Item                          Quantity     Price

1. ___________    _____________________________  _______   _________

2. ___________    _____________________________  _______   _________

3. ___________    _____________________________  _______   _________

4. ___________    _____________________________  _______   _________

5. ___________    _____________________________  _______   _________

6. ___________    _____________________________  _______   _________

7. ___________    _____________________________  _______   _________

8. ___________    _____________________________  _______   _________

9. ___________    _____________________________  _______   _________

10.___________    _____________________________  _______   _________

Add lines as you need them

Bench Racing Diecast and Collectibles
833 West Union Street
The Street Of Shops
Newark,NY.14513
Telephone: (315) 331-7843
Text: (585) 734-4463