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  • Customer Information Sheet

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    knucklehead38401
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    This document is an invoice from Tennessee Injector Service detailing injector cleaning and repair services. It requests the customer's contact and vehicle information, lists the available services and their prices, and provides fields to select payment method and shipping options. The customer is asked to enclose the form when returning their injectors for service.

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    This document is an invoice from Tennessee Injector Service detailing injector cleaning and repair services. It requests the customer's contact and vehicle information, lists the available services and their prices, and provides fields to select payment method and shipping options. The customer is asked to enclose the form when returning their injectors for service.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    8 views1 page

    Customer Information Sheet

    Uploaded by

    knucklehead38401
    This document is an invoice from Tennessee Injector Service detailing injector cleaning and repair services. It requests the customer's contact and vehicle information, lists the available services and their prices, and provides fields to select payment method and shipping options. The customer is asked to enclose the form when returning their injectors for service.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    Tennessee Injector Service

    1053 Massey Rd.


    Mt. Pleasant, TN 38474
    (931)325-5259
    Name: _____________________________________________________________ Date: ________________
    Shipping Address: _________________________________________________________________________
    City: ________________________________________ State: ________ Zip Code: ______________________
    Phone: _________________________________

    Email: _________________________________________

    VEHICLE / INJECTOR INFORMATION


    Year & Make of Vehicle: __________________________ Model: ___________________________________
    TOTAL NUMBER OF INJECTORS ENCLOSED __________ SERVICE REQUESTED (circle one)
    Clean & Flow ($20 each)

    Flow test only ($10.00 each)

    Expedited service ($25 each)

    Install hoses ($5 each)

    Other, specify below

    Additional information or special instructions:


    ___________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________

    PAYMENT METHOD

    MC

    Visa

    PayPal

    Acct #________________________________________________

    Money Order

    Exp. Date: ____________________

    Full name as it appears on Card ____________________________________________________________


    Billing Address: __________________________________________________________________________
    (if different than shipping address)
    City: _______________________________________ State: ________ Zip Code: ______________________
    I agree to pay according to card issue agreement: ______________________________________________
    (Must be signed for credit cards)
    Signature
    Return shipping is $10.00 via USPS flat rate priority mail that includes $100 insurance. If additional insurance is required, add $1.00
    per $100 additional insurance, up to a maximum insurance of $500. Please wrap your injectors separately and place in a plastic bag
    before shipping. Please enclose this form with your injectors.
    Extra Insurance: _____________________ ($100, $200, $300, $400, $500)
    Thank You for your Business!

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