Parts Order Form

Parts Order Form

A J Weston Inc.
12345 N 1st St.
Suite 2011B
Tempe, AZ, 85262

Order by Phone: 602-555-5555

Select your parts below

Part Description

Price

Quantity

Total

Extractor 9mm .380 15

SLB - black - 9 &.380

SLB - black - for .380

Locking Block - G19

Magazine Floor Plate

Recoil Spring Assembly

Sub-Total:

Tax (AZ 8.10%):

Shipping & Handling ($14.00):

Grand Total:

Customer E-Mail

E-Mail:*

Billing Information

First Name:*

Middle Initial:

Last Name:*

Address Line 1:*

Address Line 2:

Phone:

City:*

State:*

Zip Code:*

Shipping Information

Same as billing information?
Yes No 

First Name:*

Middle Initial:

Last Name:*

Address Line 1:*

Address Line 2:

Phone:

City:*

State:*

Zip Code:*

Payment Information

Payment Method:*
Credit Card Other 

Card Number:*

Expiration Month:*

Expiration Year:*

Card Brand:*

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