Return Form / Referred by Pirates Lair

Name:________________________________________________
Address: ______________________________________________
City: ___________________State: ______ Zip Code: __________
Phone ________________________________________________
Email ________________________________________________
Date: ___________ Bike Model ______________Year:________

Select item Returning for service:

Front Shock           Rear Shock         Other: __________

Please circle reason for return & explain reason in detail.

Repair            Rebuild               Service                   Warranty

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Credit Card-________ ________ ________ ________

Exp date: Month___________ Yr_________ CVC________

We accept Visa, Master Card, Discover & Amer Exp.
**Please include this form in the box with your shock.
**Extreme Dirty shocks will be charged a fee of $20.

Without Completion of this entire form, the service will be delayed.