Parts order form

356 A/B Fuel Pump Parts Order Form

To place an order by mail or PayPal

Please print this form, fill out and send with payment

356 A/B Pump rebuild: $180.00 each Qty:______ _______

You will need to send old pump / 's with payment

356 A/B Pump rebuilt no core: $260.00 each Qty:______ _______

356 A/B Gasket Set: $5.00 each Qty:______ ________

356 A/B Flange gasket-shim Set: $6.00 each Qty:______ _______

356 A/B diaphragm rebuild: $26.00 each Qty:______ _______

You will need to send old diaphragm / 's with payment

356 A/B Diaphragm spring: $10.00 each Qty:______ _______

356 A/B rocker pin: $10.00 each Qty:______ _______

356 A/B Valve retainer gasket: $2.00 each Qty:______ _______

356 A/B Valve & spring set: $15.00 each Qty:______ ________

Flange O' ring: $3.00 each Qty: ______ ________

356 A/B OEM Cone Top: $28.00 each Qty:______ ________

Reproduction blinker wiring cover: $14.00 each Qty: ______ ________

Shipping and Handling: Only one S/H fee per order Parts Domestic S/H: $4.00

Fuel pump Domestic S/H: $14.00

( Outside of USA ) International Air Mail Post ,Contact me

Total $ _______

Please indicate quantity and send payment to :

Doug Feistamel

PO Box 6316

Villa Park IL 60181-5317

USA

I accept personal checks, money orders and PayPal. US $ only. When payment is received, I will ship first class USPS mail.

For PayPal, simply indicate items and quantity in PP message box, include S/H and Address.

PayPal account name: info@type356a.com

I will reply and ship within 3 days.

Include email address for reply: ____________________________________________________

SHIP TO:

Your Name __________________________________________________________________

Address __________________________________________________________________

___________________________________________________________________