ORDER FORM
DE FARMALL CUBS
WE ARE NOT ACCEPTING ORDERS OUTSIDE THE UNITED STATES AT THIS TIME.

TO ORDER: WRITE DOWN THE QUANTITY, ITEM NUMBER (FOUND BELOW PICTURE), A
BRIEF DESCRIPTION & PRICE OF THE PARTS YOU WANT & ENTER THEM IN THE FORM
BELOW.  FILL OUT THE SHIPPING & PAYMENT INFORMATION & SUBMIT.  

Once we receive your order, we will send an invoice if paying with Paypal or by credit card.    
To avoid "undelivered" invoices, please add  
 done45nut@yahoo.com  to your approved
contact email list.  
ITEMS OR SECTIONS MARKED WITH A   
 R     ARE REQUIRED.

IMPORTANT! DO NOT HIT YOUR "ENTER" BUTTON BEFORE COMPLETING THE
FORM, AS THIS MAY AUTOMATICALLY SUBMIT THE FORM.

PRIVACY POLICY

Our customers privacy is
very important to us.

DE FARMALL CUBS does
not rent, sell, or share
personal information
about you with other
people or companies.  
The information you
provide on the order
form is only used to fill
your order.
ORDER FORM
R
FIRST NAME
LAST NAME
R
COMPANY
R
ADDRESS 1
ADDRESS 2
ZIP
CODE
R
CITY
R
R
TEL.
R
EMAIL
R
EMAIL ADDRESS MUST BE CORRECT
PLEASE INCLUDE AREA CODE  
TELEPHONE NUMBER REQUIRED ON
ORDERS PAID WITH CREDIT CARDS
R
R
R
R
PRICE
ITEM NUMBER
QTY
NAME OF PART
EXAMPLE
BR-071
1
BRAKE DRUM
$51.99
SHIPPING METHOD
SHIPPING IS FREE!
WE USE STANDARD SHIPPING
PAYMENT
R
INVOICE SENT  BY EMAIL  -  YOU PAY SECURELY ONLINE WITH YOUR VISA,
DISCOVER, MASTERCARD OR AMERICAN EXPRESS CREDIT CARD.
A PAYPAL ACCOUNT IS NOT NECESSARY.
PAYPAL-
CALL FOR MY CREDIT CARD INFORMATION*  
TAX EXEMPT - CHECK BOX IF TAX EXEMPT & FORM IS ON FILE WITH US.
* BEST TIME FOR US TO CALL
DAYTIME
EVENING
ANYTIME
8:00 - 5:00 PM           AFTER 6:00 PM CST
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