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TELL US WHO YOU ARE . . .

NAME

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TELEPHONE #

ADDRESS

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TELL US ABOUT YOUR AUTO . . .

VIN (vehicle identification number)

YEAR

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MAKE/MODEL

PART

TRANSMISSION TYPE

Automatic Stick
3-Speed 4-Speed 5-Speed Other

BODY STYLE

2-Door 4-Door Hatchback Nochback Other

ABS Brakes?

Yes No

ENGINE SIZE

WHEEL SIZE

ADDITIONAL INFORMATION

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Copyright © 2001 Jimmie's Auto Parts, Inc. All rights reserved.
Revised: June 11, 2001.