Clean & Flow 4 Injectors

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Injector Service Form

Package injectors utilizing a USPS flat rate box or protective envelop. Wrap your injectors in a suitable protective material to prevent banging together. Include this form with your injectors for Service. 

Send to:

wPrevattAutomotive

12705 E 132nd Street S

Broken Arrow, OK 74011

Your Name _______________________________________ Email:______________________      

 Street Address_______________________________________ Cell:________________________              

 City_________________________ State___________________                             

 Zip Code___________________________

Service Requested:

No. Injectors Enclosed _________________ 

Flow ONLY  ____________ X 8.00 = _______________  

Clean ONLY ____________ X 11.00 = _______________   

Flow and Clean _____________X 15.00 = _______________            

USPS Priority Return Shipping  (10.50)

Additional Shipping Insurance _______________ Amount of Coverage ____________

Shipping Insurance: Add 1.75 for each 100.00 of coverage. We will not pay for any loss or damage for packages in the care of USPS so purchase insurance if you have expensive injectors

Total Enclosed:_______________________________

Payment Options :  Paypal invoice Money Order  Personal Check Visa/Mastercard

Visa / Mastercard Number: ________________________________________

Expiration Date: ________________________CVN _____________________

 Authorization Signature/ Date ________________________________/________