Please use this form to make out your order.   If you are going to make your order via telephone, please call 1-816-765-4881 during the normal business hours and ask for our sales order desk.  Identify yourself and let the sales staff know that you are making a telephone order from items listed on our web page.  Please have ready the part numbers and descriptions of the items that you are interested in.  If you are going to fax this order in, please print this form and fill out all appropriate lines in the below.  Then fax it to 1-816-765-9897.  If you want to mail this to us, please mail to the address at the bottom of the page.  Thank you for visiting A.R.I. Racing Engines!

Shipping & Payment Information:

Phone Number:________________________________________________________
Shipping Address:______________________________________________________
Payment Method:              [  ] Visa         [  ] Mastercard          [  ] Cashier's Check
Name on Credit Card: _________________________ Signature: _____________________
Credit Card # : ____________________________________Exp. Date: _________________________
Billing Address: ________________________________________________________


Part # Description Quantity Price Amount
    Sub Total:  
    MO Residents add 7.1% Sales Tax:  
    Shipping & Handling:  

Anderson Racing Inc. 3911 Main St. Grandview, Missouri 64030
Phone: 816-765-4881 | Fax 816-765-9897