183 Lake Blvd. East Redding, CA 96003 Phone: 800-792-BOYS Fax: 530-244-0933	Date:
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Bill To:		Ship To:
	Bill To Phone Number:		Ship To Phone Number:

Car Information: Bus 1950 to 1967 Westfalia Camper Bus 1968 to 1979 Sundial Camper Vanagon USA Manufacture Camper Single Cab Pickup Sunroof Model Crew Cab Pickup Other  Eurovan Year: Chassis Number:   Credit Card Information: Account # Exp.  Date (Month / Year) CVV2 Code on Card  Exact Name on Card:

Payment: Prepay-Personal Check Visa Mastercard Prepay-Money Order  Am Ex Prepay-Certified Check Shipping Information:   DHL  Ground DHL  Next Day Some Area Restric US Priority Mail (insured over $50) DHL  2 Day Foreign Customer Arranged Will Call * DHL ( Shipping to Europe, Asia etc.) * Will Call Date & Time:

Please print this form and  fill out legibly in dark ink.  Mail or fax this form to Bus Boys. Shipping cost is unknown until your order is packaged.  If you are sending in a check or money order as payment, please call for shipping cost first.