WitchHunter Performance
 22833 Bothell Everett Hwy
 #1221 Suite 110
 Bothell, WA 98021
 206-919-0794

 

Name _____________________________________________________________ Date   ______________

Shipping Address  ________________________________________________________________________

City ________________________________________ State_________  Zip Code_______________

Phone  ___________________________                    Email    ______________________________

                                                  VEHICLE / INJECTOR INFORMATION

 Year & Make of Vehicle __________________________  Model ____________________________    

                                                   SERVICE REQUESTED  (circle one)

Clean & Flow  ($18 ea)             Flow test only ( $9.00 ea)             Other, specify below

Additional information or special instructions: __________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

                                                                 PAYMENT METHOD (circle one)

MC                Visa                    PayPal             Money Order

Acct #________________________________________________        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:__________________________________________
          (for credit cards only)                                                               Signature

 $10.00 flat rate for return shipping by priority mail that includes $100 insurance.

Please pack your injectors separately and place in a plastic bag.