There are three EASY ways to order our products:

- By PHONE : 1-800-980-3517 or 1-217-932-6485

- By FAX : (Send completed form to) 1-217-932-6486

- Or ON-LINE : (Fill out the form below!)

...Question or Order - REQUIRED!

Personal Info:1

...Name - REQUIRED!
...Home / Billing Address (No P.O. Box)
...City  ...State
...Zip
...Country
...Day Phone
...Evening Phone

Ship To: (if different than above)

...Name
...Company
...Address (No P.O. Box)
...City  ...State
...Zip
...Country

Items Ordered:

...Quantity  ...Item

...Year of Vehicle
...Make of Vehicle
...Model of Vehicle

...Quantity  ...Item

Is this item for the same Vehicle above?  Yes  No
...Year of Vehicle
...Make of Vehicle
...Model of Vehicle

...Quantity  ...Item

Is this item for the same Vehicle above?  Yes  No
...Year of Vehicle
...Make of Vehicle
...Model of Vehicle

Shipping and Handling:

  Standard Ground  - $7.50 (Domestic)
  2nd Day Air - $12.50 (Does not include Hawaii)
  Overnite Air - $27.50 (Does not include Hawaii)
  International Shipping - Call for quote
      NOTE: There will be an additional $5 charge to ship custom
                   tail lights due to insurance & size of package.
 

...Special Handling (From Above) - REQUIRED!

All orders are normally shipped within 3 business days of receipt of order.

Credit Card Information:

If you do not wish to include your credit card, please include a comment below to that effect, and we will contact you via telephone.

...Credit Card
...Account Number     ...3 Digit Security Code (Back of Card)
...Expiration Date (Month / Year)

Additional Information:

All orders are normally confirmed within 24 hours of receipt or order via E-Mail.

...Your Email Address - REQUIRED!

Comments:

                M. D. Wright, Inc.
                4701 East 870th Road
                Casey, IL  62420
                800-980-3517