TO: AUTOINSTRUMENTS CORP.
2125 Virginia Ave.
Collinsville, VA 24078
TOLL FREE 877-450-0110
FROM: ______________________________
IS THIS THE ADDRESS WHERE YOU’D LIKE THE PACKAGE RETURNED?
BUSINESS NAME:________________________
STREET________________________________
CITY__________________________________
STATE/ZIP_____________________________
COUNTRY_______________________________
DAYTIME TELEPHONE NUMBER _____________
HOME TELEPHONE NUMBER_________________
CONTENTS: (PLEASE LIST INDIVIDUAL PARTS AND TOTAL AT BOTTOM).
1.__________________________________________
2.__________________________________________
3.__________________________________________
4.__________________________________________
5.__________________________________________
6.__________________________________________
7.__________________________________________
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Email address:_______________________________
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****PLEASE NOTE: WE WILL BE CALLING YOU WITH AN ESTIMATE AFTER WE BENCH-TEST THE ITEM(S) AND BEFORE ANY WORK IS PERFORMED! WE WON’T DO ANYTHING UNTIL YOU TELL US WHAT TO DO! THERE IS NO OBLIGATION, IF YOU DON’T WANT THE WORK PERFORMED FOR ANY REASON JUST LET US KNOW AND WE’LL RETURN IT TO YOU AT NO CHARGE!
Make and model of car:_________________________________________________
INSTRUCTIONS:________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
HOW WOULD YOU LIKE TO PAY FOR THIS:
VISA __ / MASTER CARD __ / DISCOVER __ / AMERICAN EXPRESS __
CARD NUMBER ___________________________
EXPIRATION DATE _______________________
“V” CODE (LAST THREE DIGITS ON BACK OF CARD_________
How much insurance would you like during return shipping? $____________
(UPS only charges about forty cents per hundred dollars value, so $1000 worth of insurance is only about four bucks!)
Billing address for credit card if different from shipping address above:
NAME ___________________________
BUSINESS NAME_________________
STREET ADDRESS________________
CITY/STATE _____________________
ZIP_____________________________
