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I C T O R Y
Stroker Flywheel and Piston Order Form

   You must request a postage quote before making payment: Please give me the shipping charge for the following parts to my address.. You MUST make FULL payment WITH THIS ORDER by Postal or bank money order (no checks, no credit cards), payable in U.S. Dollars exactly as follows: “Bank of America”. Any other endorsement or error will be destroyed. Absolutely NO CODs. Do not use registered mail or any other method which requires a signature, causing me to waste an hour waiting at the Post Office.
   To order, PRINT THIS PAGE

. Print neatly & clearly in the boxes below: your NAME & ADDRESS, TELEPHONE NUMBER, quantity desired, part number, complete description of the product (including oversize,etc.) price each, and total price. Indicate how much money (US dollars only) you have enclosed.
   ALL orders will be sent by U.S. Priority Mail International (airmail) ONLY.

MAIL this page to:

Victory Library
515 Greengrove Avenue
Uniondale, NY
11553-2130
U.S.A.

Your NAME & ADDRESS:
 
 
 
 
 
 
 
TELEPHONE NUMBER: 
 

Line

Qty

Part No.

Description, stroke length, motor type, piston oversize, etc.

Price

Total

1

         

2

         

3

         

4

         

5

         

Total for items only:

Postage charges from e-mail quote:

If paying by money order, add $4.00 bank fee:

Grand total enclosed, payable by cashiers check or money order to “North Fork Bank”:

Grand total enclosed, payable by cash: