Belaire Kick Panels Order Form

Directions:

Print this form and mail it to JS Classics along with your check or money order. Or, send us the form and email your payment via our PayPal account. Be sure to complete the Contact and Payment Information (field names in bold indicate required information) and then select the items you want to order. A JS Classics representative will contact you within 48 hours.

Contact Information
First Name:
Last Name:
Mailing Address:
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Country:
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Telephone Number:
Payment Information
Payment Method:	Personal Check  Money Order  PayPal Account
PayPal email:	jsclassics@hotmail.com
Payment Amount:	Please include your payment along with your order.

1955-'56 Belair/210 Panel
Order Number	Price*	Description
B55-80w	$125.00 pr	Pair of kick panels with 80 watt speakers
B55-120w	$180.00 pr	Pair of kick panels with 120 watt speakers
B55	$72.50 pr	Pair of kick panels without speakers (has precision cut speaker hole)
1957 Belair Panel
Order Number	Price*	Description
B57-80w	$125.00 pr	Pair of kick panels with 80 watt speakers
B57-120w	$180.00 pr	Pair of kick panels with 120 watt speakers
B57	$72.50 pr	Pair of kick panels without speakers (has precision cut speaker hole)
(* Add $10.00 shipping and handling to all prices. Applicable taxes are included in all prices.)
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