Bumper Inserts Order Form:
Print this form. Fill it out and include it with your order.

Your Name______________________________________

Your Address:____________________________________

_______________________________________________

_______________________________________________

Your Email:______________________________________
(For order status. We will ship to above address.)

Do you want us to Email you when we send out your order ? (yes/no)_________
Please print email address clearly if you want to be notified.

What year and model is your Mustang_________________.
Our kits currently cover '87 - '2000 Mustangs.

Circle which style: ... COBRA .... MUSTANG GT..... MUSTANG
This will determine which bumper inserts are shipped to you.

Which COLOR do you want (circle one):
Black.....White.....Red.....Yellow.....Blue.....Gray.....Dark Gray.....Mustard
Custom_________________________

TOTAL Order Quantity________________ kits.

PRICE: Bumper insert kit $12.

Mustangworld Club Member Cost $10 per kit.
MWCLUB Number________________________.

TOTAL ORDER AMOUNT (US$)_________________.
(If sending a check, Make checks payable to Mustangworld.com)

Shipping and handling is included.

CA residents add %7.75 SALES TAX to your order.

Mustangworld.com, 2134 Newport Blvd., Costa Mesa, CA 92627.

(MWbumper insert order form part no. 020999rev2.)