Print form and mail to: BUGCITY LLC 51 Rowley Street Berlin, CT 06037 Toll Free: 1-888-BUGCITY (1-888-284-2489) Within CT: 860-666-CITY (1-860-666-2489)

BUGCITY MAIL-IN ORDER FORM

Please Print Please send my order for the items I have listed below. I am paying for this order by: MasterCard__       Visa__       Discover__ Check__     Money Order__     Cash__ Credit Card Number (if applicable): ______________________________________________________ Exp Date ___________ Signature __________________________ E-mail Address __________________________________________ (for order shipment notifications)

Shipping Address: Name ____________________________________________________ Address __________________________________________________ City/State/Zip _____________________________________________ Phone ____________________________________________ Credit Card Billing Address (If different than above): Name ____________________________________________________ Address___________________________________________________ City/State/Zip _____________________________________________ Phone ___________________________________________

Item Number	Item Name	Quantity	Price Ea.	Total

Merchandise Total
Shipping
Connecticut Residents add 6% Sales Tax
Total Amount Enclosed

Thank you for your order.

Shipping Fee Calculation Chart:

TOTAL ORDER	Ground
Up to $50.00	$8.00
$50.01-$100.00	$10.00
$100.01-$250.00	10% of Order Total
$250.01-$500.00	5% of Order Total
Over $500.00	Free

for EXPRESS 3-DAY AIR SHIPPING of non-oversized items ADD $10.00 for EXPRESS 2-DAY AIR SHIPPING of non-oversized items ADD $15.00 Next-day air prices must be quoted by calling BUGCITY direct Rates are for shipping to Continental US destinations. If you live in Hawaii, Alaska, Canada, or other countries please call for shipping rates. International credit cards not accepted. Special shipping rates may apply on large items shipped by truck or air service. We will attempt to notify you by phone or email if these additional charges apply to your order. Add an additional $15.00/each for shipping of floor pans, heater channels, bottom plates and bumpers. Hoods are shipped via Truck Freight and shipping charges are calculated offline. Windshields #111845101K5 and #113845101D are shipped at $25.00 crate charge only. We do not ship any other windshields listed on the site Please allow a minimum of 2 to 7 business days for arrival of in-stock merchandise. View our US delivery time map for more information. If you have not received your order after the time indicated on the map, call us to check the status. Please remember that Saturdays, Sundays, and Holidays are not considered shipping days. Our policy is and has always been to satisfy every customer. If you are not satisfied with any item purchased from us, you may return it within 30 days, with a copy of the invoice/packaging slip for refund or credit. All returns must have a return authorization number. Please call us prior to returning any item. Notify us within 48 hours of receipt of shipment of any damaged or defective merchandise. Items returned for other than damage or defect must be in saleable condition.