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BIG BORE KIT ORDER FORM

APTEC Ltd
Southbrook Road
Gloucester GL4 3DN


Please print this form, complete and include with your cylinders.

NAME:
TEL:
ADDRESS:


POSTCODE:
E-MAIL:
DATE SENT:
DATE NEEDED:

BIKE INFORMATION:
MAKE:    MODEL: YEAR:
 
Please supply me with the services and or parts specified below:
 
MAX POWER HAT(s) Quantity  ............. Color Blue     Color Black 
TOP END BEARING
CYLINDER EXPRESS
BIG BORE KIT:
STAGE
ONE
STAGE
TWO
STAGE
THREE
STAGE
FOUR
STAGE
FIVE

When sending your cylinder for a Big Bore kit, please make sure to include your cylinder, head and power valve all in tact. We will re-install before delivery.
 
Signature:  Print:
 Date: 

  

OTHER INFORMATION: (please provide as much information about your jetting,
gearing, and aftermarket add ons - such as pipes, silencers, reed cages etc.)

  
  
  

PAYMENT METHOD:
On receipt of your cylinder or parts we will send you a proforma invoice. We accept payment by Visa (by phone or email) or by cheque (4 day clearance).

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

VISA  (Please enter your card details and sign below)
CHEQUE  
  
Cardholder's Name:
Card Number:
Expiration Date:
3-Digit Security Code:
  
I authorize Aptec Ltd to charge for services received:
  
Cardholders Signature:
   
 
Please remove below label and adhere to box when shipping (cover with clear tape)
 
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APTEC Ltd
Southbrook Road
Gloucester
GL4 3DN
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Primary communication point:
Telephone: 01452 300800
Fax: 01452 500400
Email: aptec@poeton.co.uk
Web: http://www.poetonaptec.co.uk
APTEC Ltd
Southbrook Road
Gloucester
GL4 3DN