ONLINE INTERIOR ORDER AND WAIVER FORM
3201 S. STANDARD AVENUE, SANTA ANA, CA 92705 · www.danchuk.com
Orders (800) 648-9554 · Inquiries (714) 751-1957 · FAX (714) 850-1957
PLEASE COMPLETE THIS FORM AND CLICK SUBMIT AT THE BOTTOM THE PAGE
CUSTOMER INFORMATION
SOLD TO:
SHIP TO:
Street Address:
Street Address:
City/State/Zip:
City/State/Zip:
Country:
Country:
Phone Number:
Phone Number:
Email Address:
Email Address:
Customer Service Rep:
Order/Quote #:
AUTOMOBILE INFORMATION
Year:  
Model:  
Body:  
Doors:  
Seats:  
Trim Number:  
Is this order for only this car?      If no, please checkmark below any parts which will not be used on the car above.
ITEM INFORMATION
Are you only requesting material samples at this time for carpet, headliners, visors, door panels, and seat covers (we will only send you material samples and will not proceed with your order until we get your confirmation)?  
Another Car? Part # Description Color Description Qty. Unit Price Extended Price
 
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$
 
$
$
 
$
$
 
$
$
 
$
$
 
$
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$
$
 
$
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$
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  Total Parts:
$
    Tax:
$
  Sub Total:
$
Shipping will be calculated at the time your order is processed.  If you have any questions regarding the shipping charges please call Customer Service at (800) 854-6911 : Shipping:
$
Click this button after all necessary gray boxes are filled out.      
FINAL AUTORIZATION

PLEASE READ ALL THE TERMS AND CONDITIONS BEFORE SUBMITTING THE WAIVER FORM:
ALL INTERIOR ORDERS ARE SPECIAL ORDERS AND THEREFORE ARE NOT-RETURNABLE.

Interiors are Special Order Items and you understand they are not returnable or exchangeable. We will only accept returns or exchanges on Special Order Items if the items are damaged or suffer from a manufacturers defect. Color Disclaimer: Due to the differences in computer monitors the colors that appear on your screen might be different than the actual color.  If an exact color match is required you can obtain a free color sample by selecting Yes to the question above under Item Information or by contacting our Customer Service Department at (800) 854-6911. Customers have the option to have sample material of carpet, headliners, visors, door panels, and seat covers mailed to them to insure you are ordering the correct color and style. Danchuk requires customers to complete this waiver form and by clicking the Submit button at the bottom states the customer agrees to the terms of the order and that colors and styles are correct. We also require interior orders to be prepaid.

Interior orders usually take 4 to 6 weeks for delivery, and carpet orders take 7 to 10 business days before shipping. Your interior item(s) will be shipped to you directly from our supplier. If you live within the State of California, your order will be shipped to us first and we will in turn ship it to you via UPS Ground unless otherwise specified. If your order is going to Alaska, Hawaii, Puerto Rico or anywhere internationally the most cost effective method of shipment will be used, unless you specify otherwise. You are welcome to call for a quote on all shipping/freight costs. Please inspect your shipment immediatley upon receipt. If there are any defective or missing parts, please notify us immediately by calling (714) 751-1957. Call as soon as possible so that we can make every attempt to rectify the situation. Due to our supplier's policies, we cannot take responsibility for any defects or shortages not reported within 10 days of receipt of order.  Interiors are duplicates of the originals.  Workmanship and fit are guaranteed by the manufacturer.  Materials are subject to change without notice; please call our Special Order Department before ordering.  Interior orders are non-returnable under normal circumstances; however, should you experience a problem with fit, workmanship, incorrect items, or damages, please call for return information.  Please do not ship your order back to us until you have contacted our Returns Department.

PLEASE CALL (800) 854-6911 WITH QUESTIONS IF YOU ARE UNSURE ABOUT ANY TERMS, OTHERWISE BY PRESSING SUBMIT AT THE BOTTOM OF THIS PAGE IS YOUR FINAL AUTHORIZATION AND IS REQUIRED IN ORDER TO PROCESS YOUR ORDER.