• 1389 W. Temple Dr, Harrison, MI 48625
  • 800-535-5943

Credit Card Authorization Form - Cooks Auto Parts, Inc.

    Ordered From:

    Card Holder Information/Billing Address

    Name:

    Street

    City

    State

    Zip Code

    Phone

    Fax

    Email

    Type of Card Being Used:

    Credit Card Number:

    Expiration Date:

    CVC Security Code:

    Please Upload a Copy of Your Credit Card Being Used:

    All Parts Are Quoted As Shipped to a Business

    Residential Delivery will be Additional! $10.00 UPS Ground; $125.00 Truck Line

    Part Requested

    Year

    Make

    Part

    Side/ID Number

    Additional Information

    Amount

    Tax ID Number

    Ship to: (if different than billing address)

    Name:

    c/o

    Street

    City

    State

    Zip Code

    Please Upload a Copy of Your Driver's License or Federal ID:

    I hereby authorize Cooks Auto Parts to charge my credit card for the above amount. I understand that this form with my signature is a binding agreement for this order. I understand this is not a receipt but an authorization. I understand my warranty will be stated on the actual receipt. Freight is NOT refundable for any reason

    Cardholder's Signature

    Call Now Button
    Simple modal box
    Part Inquiry Form