Fuel Injector Service Request Form     send with your injectors

Please print this form and fill out the info below and send it with your injectors to:

Fuel Injector Connection

5485 Bethelview Rd

Suite 360-155

Cumming, Ga 30040                    ph:770 888 1662

 att: Rebuilding Shop

Name__________________________________

Address________________________________

City_____________________St___________

Zip_______

Phone# day_________________cell_________________

make and model of vehicle:

any special instructions____________________________

_______________________________________________