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MOTO-XPERTS, INC.
1156 S. CREASY LANE
Lafayette, IN 47905
765.230.0514
Dealer____________________________________________________________________
Rider_____________________________________________________________________
Return Shipping
Address:______________________________________________________________________________
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Daytime Phone:_______________________________________
Evening Phone:_______________________________________
Make: ______________________________________________
Model:________________________________ Year:_________
Rider Weight (in gear):____________________
Classes Raced:_______________________________________
Track Types (Please check one or more)
Outdoor Motocross __ Supercross __ Woods/Enduro __ Desert __ Hare Scrambles __
Freestyle __ Short Track __ Half-Mile __ Mile __ Snocross __
Terrain (Please check one or more)
Hard Pack __ Intermediate__ Sand __ Rocks(Tight Woods) __
Work to be Performed:
Suspension: Revalve susp. __ Service susp. __ Rebuild susp. __ Linkage Service __ Chassis Setup __ Stock Shock Revalve Conversion __ Other___________________________________________________
Motor: Port/Polish __ Split Cases __ Valve Adjustment __ Carb. Rejet __ Eng. R&R __ Top end Install __ Clutch Install __ Other____________________________________________________________________
Comments:_______________________________________________________________________________
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Method of Payment:
COD __ Money Order Enclosed __ Visa __ Mastercard __ Cash __
Card Number:______________________________________________________
Expiration Date:_______________
Return Shipping:
UPS Ground __ UPS 2nd Day Air__ UPS Next Day Air __ Other________________
Note: Return shipping is not included. Please call for total amount.
Please fill this form out and attach it to an e-mail or print it and send with your components.
This sheet is for identification purposes only, we will contact you for further information when we recieve your service items.
Thank you for choosing MOTO-XPERTS.
