Welcome to Don's Diesel -- Call us at 1-800-345-6513

Order Form

To place an order you can call us Toll Free at 1-800-345-6513 or you can use this form. Print this form out, fill out the information, and mail or fax it to us.

Address:
Don's Diesel
1950 North 7th St.
Lawrence, KS 66044

Fax:
785-841-2846

Contact Information:

Name
Street Address
Address (Cont.)
City
State
Zip
Work Phone
Home Phone
Fax
Email

Order Information:

Qty	Model	Item	Description	Price	Total








				Shipping
				Subtotal

				Total

Billing Information:

Check, Cash or Money Order

C.O.D.

Visa

Mastercard

Discover

Credit Card
Cardholder Name
Card Number
Expiration Date

	Shipping Address
Street Address
Address (Cont.)
City
State
Zip
Country

Ship Via:

UPS

Air Freight

Truck

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