Race Repair / Service Order Form


Please print this form, complete and include with your cylinders



Name:______________________________________Home Phone #:_________________
 
 Work
      Phone#:_________________
 

Return Shipping
      Address:_____________________Cell Phone #:_________________
 ___________________________________________
      
E-Mail:________________________


 ___________________________________________
      
Date Sent:_____________________


                                         
           
             Bike Information:

                Make:__________________ Model:________________ Year:_________________              



 

      
 Please Supply me with
      the services and or parts specified below:


 Cylinder
      Boring & Honing  Carbide Bore
      Process to cast iron liner 
 
 Install new sleeve  Piston Kit 
 Replate Nikasil cylinder  Top end Gaskets 
 Head Work  Valve Job 
 
 Piston coatings  Blead blast cylinder or head
      
 

 Skirt
       Top
       Both
       Paint Cylinder
      


Custom or Special Work. Provide instructions below:
__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________


                                                                
  

           SHIPPING METHOD:
           We can return your cylinder and/or parts via Fedex or U.S. Postal Service Priority Mail.

           PAYMENT METHOD:
           We accept Visa, Mastercard and Discover


         I would like to pay with: (Please check one)

                                   VISA        
                                                         
                                   MASTERCARD       

                            DISCOVER        

                                  (Please complete your card information and sign below)


                                 Cardholder's Name:_______________________________

                         Card # :_______________________________

                                         Expiration Date:_____

                                 3-digit V-Code :_____

                                Billing Address :_______________________________

                             ____________________________



                             I authorize Bore Tech to charge for 
                       services received.

                            Cardholder's Signature: _______________________

Please remove below label and adhere to box when shipping
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Ship To:
Bore Tech
5977 Hutchinson Rd.
Batavia, Ohio 45103
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