Shock Service Form Please print, fill out this form and send in with shocks.

 Contact information                                         

Name	_________________________________________________________
Dealer	_________________________________________________________
Street Address	_________________________________________________________
Address (cont.)	_________________________________________________________
City	_______________________________
State/Province	_______________________________
Zip/Postal Code	______________________
Country	______________________
Work Phone	_____________________________________
Home Phone	_____________________________________
FAX	_____________________________________
E-mail	_____________________________________

          YEAR AND MODEL(1)___________________________________rebuild   re-valve

                                             (2)___________________________________rebuild   re-valve

                                             (3)___________________________________rebuild   re-valve

                      RIDER WEIGHT(1)____________(2)____________(3)___________

                    RIDING STYLE CASUAL   AVERAGE   AGGRESSIVE

           EXPLAIN

          ________________________________________________________________________

          ________________________________________________________________________

          ________________________________________________________________________

          ________________________________________________________________________

 PAYMENT INFO   MASTERCARD   VISA   DISCOVER   AMEX

CARD NUMBER	_____________  _____________  ______________  ______________
EXP. DATE	_______/________SECURITY CODE ___ ___ ___(last 3 digits on back)