Visa logo Phone (503)256-0182      FAX (503)256-3155 MC logo
Please use this form to email your order information or have this
information ready if calling in your order.


Name *req.
Address
City State Zip
Email Address *req.
Phone *req. FAX

Make *req.
(VW, Nissan, Honda)

Model *req.
(Golf,Civic,Legacy,200SX)

Year *req.

Manufacturing Date
(On driver's door pillar)

Type of transmission: *req.
Manual
Automatic

Air Conditioning: *req.
Yes
No

Engine Type (Like 2.0, 2.8, etc.) *req.

Fuel: *req.
Gas
Diesel

Please describe the parts you need in as much detail as possible. Use as much space as you need.

Thank you for your order information. We will email a quote back to you as soon as possible.