Order Form

Fuel Injection Corp
2407 Research Drive
Livermore, CA 94550
Phone 925-371-6551
Order Fax 1-800-860-7830

ORDER FORM

PO Number

R&R

Test & Check

Special

To:
Name:
Company Name:
Street Address:
City, ST ZIP Code:
Phone:

Ship To:
Name:
Company Name:
Street Address:
City, ST ZIP Code:
Phone:

SHIP VIA:
UPS Next Day UPS 2nd Day UPS 3 Day UPS Ground Postal Golden State

QTY	UNIT	DESCRIPTION	UNIT PRICE	TOTAL

***UNIT INFORMATION MUST BE FILLED OUT FOR R&R TO BE PROCESSED***

Vehicle Make: Model: Year:
Engine Size: Cyl:
Number(s) on Part:
Trouble Codes Found:
Description Of Problem(REQUIRED):

Please complete, print and fax to Fuel Injection Corporation, Order Fax 1-800-860-7830

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