Please print out this form and fax or mail it to us otherwise copy and paste the text into an email and fill in your name as your signature.

Name: _______________________________ Date: _______________
Shipping Address:


Credit Card #: ________-________-________-________     

Expiration Date: ______/_______  3 Digit Security Code: _______
Billing Address: (If different from shipping address)




If you send us a signed and completely filled out copy of this form to us, it confirms your Domestic Special Order for:

Part Number                           Description                               Quantity


Let us know immediately if you need to cancel this order!!
(Ignorance is not bliss - it’s expensive!)

All Domestic Special Orders require your credit card number, a current expiration date, your signature below, & this form in our possession to be honored. As the final price of each item may differ depending on current supplier prices, incoming shipping charges etc. You authorize, by signing below, C.Obert & Co. to charge your credit card for the final price plus insured shipping to your provided shipping address, plus tax if applicable. You also, by signing below, agree to pay the total amount according to your card issuer agreement.
    Please be forewarned that delivery time on special orders can run a day or two into a few weeks depending upon our supplier. Some are individuals with boxes of parts just like you! We do everything we can to keep on top of our suppliers, but we are dealing with diminishing items that each day become more and more difficult to obtain. 

Once the item has been ordered from our Domestic supplier, we cannot cancel the order. Many suppliers of hard to find parts do not accept returns. Therefore, we cannot provide refunds for canceled orders or returned items.
If you have special ordered an item that you no longer want, and it is too late to cancel because the order is already been processed, we can offer you one of these options:  

1.    Partial refund, the amount depends on item.
2.    Consignment sale of item.(See our Consignment Agreement)  

For option two, we will advertise your item on our website. As soon as it is sold, we will forward the proceeds of the sale to you
      In cases where our supplier neglects to ship the order (due to unavailability or error), we will cancel your order if you so desire. Otherwise, I will automatically re-order the item until it comes in, or attempt to locate your item thru a new source.

Remember, if we do not get this form completely filled out, signed, and in our possession, we will not place your special order!

We appreciate your business!

Please sign below and return this legible form ASAP so we will begin the Domestic Special Order process for you.


X___________________________ Date_____________

revised 9/21/2011