Mr Injector Service Form
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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.                                   
Port or TBI Injectors $17.50ea - (GDI) Direct Injectors $25.00ea

Send them to:                                                                      I authorize you to perform the service requested and bill my credit card or invoice me 
                                                                                            through PayPal. I assume responsibility for any loss or damage done during shipping
Mr. Injector                                                                          to or from Mr Injector that is not covered by any optional shipping insurance that 
                                                                                            I purchase. 

6280 North Government Way #4
Dalton Gardens, Idaho 83815                                            Authorization Signature____________________________________________Date_________


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_________________________________  

Return Shipping USPS Priority _________Add $7.50   NOTE: If you desire overnight or 2nd day shipping you will need to supply your own shipping return label.  We do not ship internationally except for military FPO or APO addresses.  

Add Shipping Insurance _________      Insurance Fee's __________________________    Desired Amount of Coverage  ____________________

Instructions for shipping insurance: Add $1.75 for each $100.00 of coverage you would like.  The USPS requires a signature with insured
shipping so be sure you can be available when your package arrived. We will not pay for any loss or damage for packages in the care of
USPS so purchase some insurance if you have a hard to replace set.


Payment Options: Send me a PayPal invoice__________   Money order enclosed___________    Bill my Master Card or Visa___________________

Visa or MasterCard #____________________________________________________________________________________________________

Expiration Date __________________________________________________________________________________________________________

Credit Card Authorization Signature_________________________________________________________  Date_________________________