5373 West 86th Street  •  Indianapolis, IN 46268  •  USA
(317) 334-0569  •  Fax (317) 879-9397
FAXABLE ORDER FORM

Fill out the form below, making sure to enter all the contact information so that we may contact you if there is a question on your order.

Click on the "Print this Form" button to print the form.

Fax the completed form to 317-879-9397.

We are available Monday through Friday between 8:00 AM and 5:00 PM EST, USA

NOTE: This form functions best with IE 6.0+, Netscape Navigator 6.0+, and Opera 7.0+.

If you have an older browser, the "Add row" function may not work and you may not be able to enter and print data.

Bill To: Ship To: Same as Bill To:
(please check after filling out the Bill To information)
Company Name Company Name
First Name First Name
Last Name Last Name
Address Line 1: Address Line 1:
Address Line 2: Address Line 2:
Address Line 3: Address Line 3:
City City
State/Province
Zip Code 		State/Province
Zip Code
Country Country
Contact Information:
Phone: Fax:
E-mail Address: Cell Phone:
       
Quantity Item Number Description, Cut Length, Special Requirements Add another Item?

Special Instructions for this Order:
       
Credit Card Card Number:
Example: 1234-5678-1234-5678
Expiration Date: Issued To:
Enter Name EXACTLY as it appears on your card

Please Sign Here__________________________________________________________________
Fax this signed and completed form to (317) 879-9397.  Be sure to keep a copy for your own records.

  OR  

NOTE:
SENDING CREDIT CARD INFORMATION THROUGH THIS FORM TO AED IS NOT SECURE.
As an alternative, you may either fax the form to us; or email without the credit card number, and then call or fax the credit card information.

Another option to send the credit card number to us by email:
Split the card number in half and send each half separately into TWO email messages.
Please don't forget the expiration date in one of the messages.

Example:
     Email #1: Visa Card 4xxx-xxx
     Email #2: Visa Card xxxx-xxxx, Exp xx/11

You can send the emails to dave@aedmotorsport.com

Be sure to also include the name and billing address of the credit card holder, as well as a daytime phone number.

ONE FINAL NOTE:
Orders from Nigeria, Indonesia and Malaysia require a FAXED letter of authorization,
including your full name as it appears on the credit card, PLUS the credit card number, expiration date, billing address, phone number, written authorization to charge your card, and a photocopy of the front AND back of the credit card.


Please send your fax to 317-879-9397 ~ ATTN: DAVE GORDON
If we do not receive your fax, your order will be cancelled automatically.