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. NOTE: We don't service direct (GDI) injectors or diesel injectors
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_________________________________ x $17.50 per injector = _________________________________________
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_________________________
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. NOTE: We don't service direct (GDI) injectors or diesel injectors
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_________________________________ x $17.50 per injector = _________________________________________
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_________________________