Website Order Form, Print out Form and mail or Fax To
Fatfendered Street Rod Shop
4050 N Roosevelt St.
Kingman, Arizona  86409-2624
(928) 692-2105 / Fax 928-692-2104
Call for Current Pricing

Name__________________Phone(____)________________Date______
Address_____________________________________________________
City__________________St_________________Zip_________________

Method of Payment  Check ___ Money Order___Visa____MasterCard____

Account Number_____________________________________________

Expires_________Signature____________________________________