R & R Form

* Required

PO Number	Resale Number

SHIP VIA:*

QTY	UNIT	DESCRIPTION	UNIT PRICE	TOTAL

Testing Fees - this service is an additional fee on top of the R&R fee.

To:

Name *

Company Name

Street Address *

City, St Zip *

Phone *

Email *

Ship To:

Name *

Company Name

Street Address *

City, St Zip *

Phone *

Email *

VEHICLE INFORMATION

Vehicle Make:
Vehicle Model:
Vehicle Year:
Engine Size:
Engine Cylinders:
Number(s) on Part:*
Trouble Codes Found:
Description Of Problem:* Please provide as much information as possible.

I have printed this completed form before submitting.

Please print this page out and send in with your part that you want rebuilt. Make sure the part is packaged properly to prevent damage during shipping. You may choose any carrier service to ship your package to us.

Mail to:
FIC
2246 N. MacArthur Dr.
Tracy, CA 95376