| Name:___________________________________________________________
Billing
Address:_________________________________________________
City:_____________________________ State:_______________
Zip:________
Dayime Phone:(____)_____________ Evening
Phone:(____)________________
Shipping Address (if Different from Billing)_____________________________________
City______________________________ State:_______________
Zip:________
Email Address : ____________________________
Please bill my: (Check one)
Visa Master card Discover C.O.D. cashiers check/money order
Card Number: ___________________________________ Exp.
Date:_________
Signature: __________________________Last 3 digits from back of
card______
Please return-ship package (UPS): Ground 3-Day 2-DayOvernight
List Description of Impeller(s) Sent:
____________________________________
_________________________________________________________________
_________________________________________________________________
Description of Service Requested:
______________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Additional parts requested (ie- impeller tool,
pump oil, nose boot/seal etc.):_________
_________________________________________________________________
Print, fill
out and mail this form along with your Impeller(s) to:
IMPROS Impeller Performance
610 Amigos Dr., Ste. B
Redlands, CA 92373 (909) 793-2900
Undeliverable, refused, or unclaimed packages will become
the property of Impros after 90 days.
All serviced impellers will be shipped via UPS ground
service unless specified otherwise. |
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