FASTRAC™  - PRODUCT ORDER FORM

To place your FAX or MAIL order, complete the following steps:
1) Print this form, 2) Complete the Bill To and Ship To information. 3) Indicate the Qty, Total, and Sub Total
information based on the Quantity selected. 4) If Tax Exempt, enter the Tax ID Number for your
organization. 5) Select Payment Option. 6) FAX Completed form to: (248) 628-1692
 --OR--
 MAIL to: [see address / check info in PERSONAL CHECK section below]
Once we have received your faxed or mailed order, we will calculate Shipping, Tax, and the Grand Total. We will contact you via phone or e-mail to confirm the order within 1 working day of receiving your fax or mail.
For Questions regarding your order, please phone us at: (248) 628-2222

 Bill To:

 Ship To:

 

check here if same as Bill To information...
Name    Name  
Phone   Phone  
Address   Address  
City   City  
State   State  
Zip Code   Zip Code  

 Part No:

 Description:

Qty.

Price*

Total
FT48  FasTracTM 48" $20.00
BTDC  Trac Clip $5.00
DBDT  Wheel Chock Dirt Bike Dual Trac $22.00
DBST  Wheel Chock Dirt Bike Single Trac $32.00
RBB  Wheel Chock Road Bike Black $40.00
RBC  Wheel Chock Road Bike Chrome $50.00
SSTA  Straight Single Trac Adapter $10.00
ASTA  Angled Single Trac Adapter $12.00
CTDS  Custom Tie Down Strap $15.00
FT134  FasTracTM Flange Bolt $1.25
FT516  FasTracTM Flange Nut $.50
141CHS  #14-1" Cap Head Screws (100 ct) $7.00
141CHSB  #14-1" Cap Head Screw Black (50ct) $5.00
141112HHB  1/4" - 1 1/2" Hex Head Bolts grade 5 (100 ct) $15.00
14N  1/4" Hex Nuts (100 ct) $6.00
14W  1/4" Washers (100 ct) $6.00
14LW  1/4" Lock Washers (100 ct) $6.00
   

Sub Total:

  
   *Tax ID Number:

 Tax/Non Tax*:

  
   

Shipping:

  
   

Grand Total:

  

Credit Card:

Personal Check:
Card Type

  • Checks Payable To: TOM'S HARDWARE
    (Include Drivers License # on check)

  • For FINAL TOTAL on CHECK Payments:
    E-mail or phone us at (248-628-2222)

  • Send Order Form and/or check to:
    558 South Lapeer Rd.
    Oxford, MI 48371
    Attn: Fastrac Sales
Card Number
Expiration Date
CVV#
Billing Zip Code
Billing Address#

NOTES:-Your Credit Card Statement for this order will appear with "Tom's Hardware" as the merchant.
 *Please Note:
Prices are subject to change without notice.