The Injector Perfector
95 Ramapo Road
Garnerville, NY 10923
1-888-762-5723

INFORMATION SHEET
Please print out, complete, and mail in with your injectors

Shipping Address:

*Full Name ___________________________________________________________________

*Address _____________________________________________________________________

*City ____________________________________ *State ______ *ZIP _____________________

Daytime Phone # ___________________________ Work Phone ___________________Ext #____

Email Address __________________________________________________________________

Vehicle Information

*Year & *Make of Vehicle _________________________________________________________

*Model _______________________________________________________________________

*Engine Size ___________________________ *Mileage__________________________________

Transmission is *Automatic___ *Standard___

Injector Information

Number of Injectors _____________________________________________________________

Injector Ohms Reading ___________________________________________________________

Injector Numbers _______________________________________________________________

Injector Plastic Color ____________________________________________________________

Any additional info you feel would be of help: _________________________________________

_____________________________________________________________________________

Amount quoted:______________________________________________________

Return Shipping & Handling          Express Mail ______________     Priority Mail__________________

If Paying by Credit (Visa or MasterCard only)    Card Type____________________     

       Card Number_________________________________________    Exp. Date_______

* REQUIRED FIELDS!
Express Mail - $24.95
Priority Mail - $10.95