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Tom's Differentials
900 Kootenai Cutoff, Ponderay, ID 83852
(208) 265-8111       FAX: (208) 265-5516


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Tom's Differentials specializes in rear-ends and axles.

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ORDER FORM

Date:

Name:

Shipping Address:

,    

Phone:

Fax:

Year:

Make:

License #:

Mileage:

Description

Price

Ring &Pinion

:

$

Carrier

:

$

Side Gears

:

$

Pinion Gears

:

$

Cross Shaft

:

$

Open Spider Set

:

$

Posi Spider Set

:

$

Clutches

:

$

Posi Shims

:

$

Yoke

:

$

Installation Kit

:

$

Center Bearing Set

:

$

Crush Sleeve

:

$

Pinion Nut

:

$

Side Shims

:

$

Pinion Shims

:

$

Gasket

:

$

Axle Bearings

:

$

Axle Seals

:

$

Axles

:

$

Housing

:

$

3rd Case

:

$

Front Retainer

:

$

Steel Cap

:

$

Misc.

:

$

Misc.

:

$

Misc.

:

$

Diff. Lube

:

$

Posi Add

:

$

Parts

$

Method of Payment

Tax

$

:

Install Steel Cap

$

Rebuild Charge

$

R&R

$

Authorized By

Shipping

$

:

Total

$

To Place Your Order
Fill out this form, then the form and either
Fax it to (208) 265-5516 or Call (208) 265-8111


Tom's Differentials
900 Kootenai Cutoff, Ponderay, ID 83852
(208) 265-8111       FAX: (208) 265-5516