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RACE REPAIR / SERVICE ORDER FORM
APTEC Ltd
Southbrook Road
Gloucester
GL4 3DN
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print this form, complete and include with your
cylinders. |
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| NAME: |
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| TEL: |
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| E-MAIL: |
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| DATE SENT: |
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| DATE NEEDED: |
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| BIKE
INFORMATION: |
| MAKE: |
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| MODEL: |
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| YEAR: |
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Please supply me with the services and or parts
specified below: |
| Cylinder
Plate & Hone to Stock size |
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Weld
Repair (additional £30.00) |
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| Wiseco pro-Lite Piston Kit |
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Hone
Repair only (additional £20.00) |
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| Top End Bearing |
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Cometic
Gaskets |
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| CYLINDER EXPRESS |
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| Xtreme
Piston: Size & Part No |
............................................................. |
Quantity |
............. |
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| 2
Stoke Cylinder porting:
(additional £55.00) |
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| LOW
to MID Porting |
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| MID
to TOP Porting |
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| All
over performance Porting |
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Additional
Services
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OTHER
INFORMATION: (please provide as much information
about your jetting,
gearing, and aftermarket add ons - such as pipes,
silencers, reed cages etc.)
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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)
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| VISA |
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(Please
enter your card
details and sign below) |
| CHEQUE |
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| Cardholder's
Name: |
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| Card
Number: |
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| Expiration
Date: |
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| 3-Digit Security Code: |
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I authorize Aptec Ltd. to charge for
services received:
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| Cardholders Signature: |
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| 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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