Print this form and fill it out by hand or click here to fill out an electronic PDF form. If you choose the electronic form fill it out then print it and send it in with your injectors.
Package your injectors and send them in with this form. the pintle pins are easy to damage so if any of the caps are broken wrap some tape around the tip to protect it. USPS has a flat rate envelope or box at a discount rate. Tape the box shut on the ends and flap for extra security. Bubble or paper wrap the injectors to protect them.
Send them to:
Mr. Injector
6280 North Government Way #4
Dalton Gardens, Idaho 83815
Name________________________________________________________________ Address__________________________________________________________________________
City__________________________________________________________________ State_____________________________________________________________________________
Zip_________________________________________________ email_______________________________________________________________________________________________
Phone________________________________________________________________ Cell______________________________________________________________________________
Make_________________________________________________________________ Model____________________________________________________________________________
Year__________________________________________________________________ Engine___________________________________________________________________________
Reason for service: Maintenance_________________________ New Engine____________________________________ Problems____________________________________
NOTES: If you answered problems describe the problem __________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________
Total number of injectors enclosed_________________________________ x $16.00 per injector = ______________________________________________________________
Return Shipping USPS Priority ______________Add $5.00 USPS Express________________Add $20.00 USPS International Express_______________Add $30.00
Payment Options: Send me a PayPal invoice______________ Money order enclosed__________________ Bill my Master Card or Visa __________________________
Visa or MasterCard # ____________________________________________________________________________________________________________________________________
Expiration Date _________________________________________________________________________________________________________________________________________
Authorization __________________________________________________________________________________________________________________________________________
Package your injectors and send them in with this form. the pintle pins are easy to damage so if any of the caps are broken wrap some tape around the tip to protect it. USPS has a flat rate envelope or box at a discount rate. Tape the box shut on the ends and flap for extra security. Bubble or paper wrap the injectors to protect them.
Send them to:
Mr. Injector
6280 North Government Way #4
Dalton Gardens, Idaho 83815
Name________________________________________________________________ Address__________________________________________________________________________
City__________________________________________________________________ State_____________________________________________________________________________
Zip_________________________________________________ email_______________________________________________________________________________________________
Phone________________________________________________________________ Cell______________________________________________________________________________
Make_________________________________________________________________ Model____________________________________________________________________________
Year__________________________________________________________________ Engine___________________________________________________________________________
Reason for service: Maintenance_________________________ New Engine____________________________________ Problems____________________________________
NOTES: If you answered problems describe the problem __________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________
Total number of injectors enclosed_________________________________ x $16.00 per injector = ______________________________________________________________
Return Shipping USPS Priority ______________Add $5.00 USPS Express________________Add $20.00 USPS International Express_______________Add $30.00
Payment Options: Send me a PayPal invoice______________ Money order enclosed__________________ Bill my Master Card or Visa __________________________
Visa or MasterCard # ____________________________________________________________________________________________________________________________________
Expiration Date _________________________________________________________________________________________________________________________________________
Authorization __________________________________________________________________________________________________________________________________________
