Aptec Motorsport - Service Order Form

Race Repair/Service Order Form?

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BIG BORE KIT ORDER FORM

APTEC Ltd
Southbrook Road
Gloucester GL4 3DN

Please print this form, complete and include with your cylinders.

NAME:

TEL:

ADDRESS:

POSTCODE:

E-MAIL:

DATE SENT:

DATE NEEDED:

BIKE INFORMATION:

MAKE:

MODEL:

YEAR:

Please supply me with the services and or parts specified below:

MAX POWER HAT(s)

Quantity

.............

Color Blue

Color Black


TOP END BEARING
CYLINDER EXPRESS

BIG BORE KIT:

	STAGE ONE	STAGE TWO	STAGE THREE	STAGE FOUR	STAGE FIVE

When sending your cylinder for a Big Bore kit, please make sure to include your cylinder, head and power valve all in tact. We will re-install before delivery.

Signature:

Print:

Date:

OTHER INFORMATION: (please provide as much information about your jetting,
gearing, and aftermarket add ons - such as pipes, silencers, reed cages etc.)

PAYMENT METHOD:
On receipt of your cylinder or parts we will send you a proforma invoice. We accept payment by Visa (by phone or email) or by cheque (4 day clearance).

I would like to pay with: (please check one)


VISA		(Please enter your card details and sign below)
CHEQUE

Cardholder's Name:
Card Number:
Expiration Date:
3-Digit Security Code:
I authorize Aptec Ltd to charge for services received:
Cardholders Signature:

Please remove below label and adhere to box when shipping (cover with clear tape)

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APTEC Ltd
Southbrook Road
Gloucester
GL4 3DN

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