WitchHunter Performance
15321 Main St NE. Ste 102
PO Box 219 - PMB 161
Duvall WA 98019


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  ($22 ea)             Flow test only ( $10.00 ea)            Install hoses ($5 ea)

    Expedited service ($25)              Other, specify below

Additional information or special instructions:

 



 PAYMENT METHOD    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:______________________________________________
        (Must be signed for credit cards)                                     Signature

 $10.00 flat rate for return shipping by priority mail that includes $100 insurance. If additional insurance is required, add $1.50 per $100 additional insurance, up to a maximum insurance of $500. Please wrap your injectors separately and place in a plastic bag before shipping. Prices subject to change without notice. (Revised 1/30/13).