CUSTOMER INFORMATION

COMPANY NAME : __________________________________ ACCT. NO : ______________
ADDRESS : _________________________ CITY : _______________ PROV : ______________
POST CODE : __________ TEL. NO : _________________ FAX NO : __________________
CONTACT NAME : _______________________________ TITLE : ____________________
P.S.T. NO: ___________________________

INSTRUMENTATION- CLUSTERS- DIC-HUD-CRT

PART NO : ________________________ ITEM DESCR: ______________________________
VEHICLE MAKE : _________________ YR : _________ MODEL : _____________________
ODOMETER : ________________ COMPLAINT : _________________________________
VEHICLE V.I.N.

1988-91 C/K TRUCK and DIGITAL RATIO ADAPTOR MODULES (DRAB/DRAC)

AXLE RATIO : _____________ TIRE TYPE : _______________ TIRE SIZE : _____________
TIRE DIAMETER : __________ inches. (Required if type and tire size not available.)

AUDIO VIDEO OR OTHER PRODUCTS

PART / MODEL NO : ______________________ SER NO : ___________________________
PRODUCT DESCRIPTION : ______________________________________________________
COMPLAINT : _________________________________________________________________
______________________________________________________________________________

METHOD of PAYMENT


[ ] VISA	[ ] MASTER CARD		[ ] CERT CHEQUE	[ ] ON ACCT	[] AMX	* Sorry, NO C.O.D.
NO: _______________________ EXP. DATE: ___________________
Note ......		ALL PRODUCTS MUST BE SHIPPED TO CEI PRE-PAID, CAREFULLY PACKAGED.
		COLLECT SHIPMENTS WILL NOT BE ACCEPTED.
		PRODUCTS ARE RETURNED PRE-PAID BY COURIER UNLESS DIRECTED OTHERWISE.

SHIP DEFECTIVE PRODUCTS TO:

( PUROLATOR RECOMMENDED)

CUSTONE ELECTROMOTIVE INC.
1150 CHAMPLAIN COURT
WHITBY, ONTARIO L1N 6K9 CANADA

(Please print out this mailform, and attach the completed form to your defective product.)

Back to Custone Homepage