Route 66 Order form 

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*Just fill out and email to bruce@getyourkicksatroute66.com 
When I get your order we will call you for your payment information.


Your name 	:
	 
Your address 	:
Your City 	:
Your State	:
Your Zip 	:
Your Tel 	: 

Your day Tel 	:
Email 		:

Items enter as many lines as you want 

Part Number Quantity Price Item Total 
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*After order is processed you will receive an email 
with your shipping information.