Please print this entire form and mail it (along with your payment) to:

Doctor Speed
PO Box 4304
Winter Park, FL 32793

Please be sure to mark your options for each item in order to make sure you receive the correct item.
Dakota Products

Intakes (FREE Shipping)
(for 4.7L Models ONLY)
Cold Air Intake - $169.95
Red
Blue
Yellow

Decals (add 3.95 S&H)
Doctor Speed Decals (medium) - $2.95
Silver
Black
White

Doctor Speed Windshield Banner - $14.95
Silver
Black
White



Contact/Shipping Information
Name:_________________________
Address 1:____________________________________
Address 2:____________________________________
City/State/Zip:_________________________________

Email:_____________________________________
Vehicle Make/Model/Year:____________________

Total Number of Items Ordered:_____
Total Amount Enclosed:___________
I have enclosed a:
Money Order (preferred)
Cashiers Check
Personal Check (Please allow 5-7 business days to clear)


Make Payable to "Doctor Speed" and mail to:
Doctor Speed
PO Box 4304
Winter Park, FL 32793


You will recieve email confirmation when your payment is received and tracking information when your item has been shipped.

Thank You for choosing Doctor Speed! We sincerely appreciate your business.