Big Glass Kit Order Form

We currently accept checks and money orders. Please complete this form and print it out. Please do not forget to include this with your check or money order before mailing.

Important Information:

Name:		Phone:
Address:		E-mail:
City:	State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Zip Code:

Please choose the correct options for your order!

OPTION 1:   $549.00	OPTION 2:   $899.00	OPTION 3:   $1149.00
includes...	includes...	includes...
• Metal Cab Section	• Metal Cab Section	• Metal Cab Section
– Inside and outside       panels fully assembled	– Inside and outside       panels fully assembled	– Inside and outside       panels fully assembled
	• Glass (stock tint    [blue/green] or gray)	• Glass (stock tint    [blue/green] or gray)
	• Rubber trim (no groove)	• Rubber trim (with groove     for chrome)
		• Chrome trim
• shipping - $110.00	• shipping is $170.00	• shipping is $170.00
Best for 1953 - 1955	Best for 1953 - 1955	Best for 1956
	Glass Window Tint:	Glass Window Tint:
	• blue/green  • gray	• blue/green   • gray
TOTAL: $659.00	TOTAL: $1069.00	TOTAL: $1,319.00

Products are in Stock and orders ship the next day!

Please send Check or Money Order and This Form to:

Mike Chesser  608 Braselton Hwy  Lawrenceville, GA 30043

Thank you very much for your order!

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