Road/Race Order Form


Please copy and paste into an e-mail and fill out this form.  Send it to:
If you are uncomfortable sending your credit card number by e-mail, send us all the information by e-mail and a number to call you at. Please indicate the best time to call. We can call you for the credit card number. You may also print it out and fax it to (562) 777-1562  

Read First > Credit Card Usage and Shipping Info

Name:  (Which will be the same as it appears on your credit card)


Credit card billing address: (Which will also be the shipping address)

Street Address ________________________________________________

City ______________________ State________ Zip Code __________

Home Phone     ______-_____________

Cell Phone         ______-_____________

Year of Car ______ Model  of Car______________Turbo___ FWD___ AWD___

4 Cyl________        V-6________   5 Speed_________   Automatic____________

E-Mail Address ____________________________

Payment info:

We no longer accept American Express. We take VISA, M/C and Discover only. 

Card Number: ______-______-______-______ Expiration Date:________

Additional 3 numbers on the back of your card (on the signature strip) _______

Credit Card   _______     or     Debit Card ______

Bank Phone number on the back of your card ______-____________


All orders shipped UPS Ground. Air options are available for repeat customers only, using the same credit card and shipping to the same address as previous orders (more than 2 weeks prior!). We do not have the time to properly do all the necessary security checks for new customers to be able to ship orders the same day or possibly the following day.  If you are a prior customer, please mention that  you want your order shipped by air (at a higher freight charge, of course)  and also your time constraints.   Make sure you give us a phone number where you can be reached between 11-3 Pacific time. We'll do our best to meet your time requirements, but if we can't  we want to be able to let you know. Regular UPS Ground delivery takes 3-6 business days depending on where you live.

Item #1 _________________________________________Price______

Item #2 _________________________________________Price______

Item #3 _________________________________________Price______

Item #4 _________________________________________Price______

Item #5 _________________________________________Price______

Contact Road///Race Engineering
13022 La Dana Ct. Santa Fe Springs, Ca 90670
Tel (562) 777-1522        Fax (562) 777-1562