This PDF 1.6 document has been generated by Acrobat PDFMaker 10.1 for Word / Adobe PDF Library 10.0, and has been sent on pdf-archive.com on 01/05/2016 at 23:52, from IP address 73.138.x.x.
The current document download page has been viewed 353 times.
File size: 117.86 KB (2 pages).
Privacy: public file
DUCK PARTS UNLIMITED
Service Request Form
Please complete and enclose this form with your parts
Year: ______ Make: __________ Model: ____________________ Millage: ___________
VIN: |____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|
CHECK TYPE OF SERVICE REQUESTED
□ Lost Key Option 1 □ Lost Key Option 2
□Dash Service
( Virgin, Clone, Mileage Correction )
□ Lost Key Option 3 □EXTRA Security
□ECU Service
( Virgin, Remove IMMO, Flash MAP )
CHECK ALL ITEMS ENCLOSED AND HOW MANY
□ ECU __
□ Dash __
□ Black Key __ □ Ignition Switch __ □ HFCU __ □ Fuel Cap
□ Red Key __ □_______________ □___________________
CONTACT INFO & RETURN SHIPPING ADDRESS
Name: __________________________________________ Country: _________________
Address Line 1 : ___________________________________________________________
Address Line 2 : _______________________________ Province: ____________________
City: ___________________________ State: _____________ Post Code: _____________
Phone: ____________________ eMail: _________________________________________
ADDITIONAL COST RETURN SHIPPING
□USPS Express/EMS
□DHL
□UPS
□FedEx
□USE MY ACCOUNT __________________________________
Special Instructions: ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Page 1 of 2
Shipping: We use USPS Priority Mail for domestic and International shipping. All shipping costs
stated on the webstore include full insurance against loss or damage. If you prefer to use
another courier like FedEx, DHL or UPS please include a pre-paid return shipment label with
your package or provide us with your shipper’s account number and check the appropriate box on
this form.
Unclaimed Items: We cannot hold customer items indefinitely. If we have not heard back from
you within 30 days of work completion, items may be disposed of.
Correspondence and Communication: We highly recommend using email to correspond regarding
your job. This way you have everything in writing and there is no confusion. Furthermore, due to
our work load, you will many times get an answer to your questions faster by email.
WORK ORDER AUTORIZATION
I hereby authorize Duck Parts Unlimited to perform the previously described work on the
enclosed parts. By signing below I acknowledge that I own or have the authority to order the
above mentioned work on the items shipped and the information provided is true to the best of
my knowledge.
If I am doing work on behalf of a customer, I have verified proper ownership and will gain
his/her permission to have this procedure done. I will collect his/her telephone number full
name, address and VIN.
If this is my personal vehicle, I am enclosing a copy of my Government issued picture I.D. and a
copy of the vehicle title and/or registration (not required for all programming, ask us if you are
not sure).
□ Clear copy of State Issued Photo ID Included
□ Clear copy of Proof of Ownership Included
Authorizing Signature: __________________________________
Printed name: _________________________________________
SHIP PARTS TO: Duck Parts Unlimited
c/o Oscar
Contact us at:
support@duckpartsunlimited.com
2111 NW N River Dr, Ste 310
Miami, FL. 33125
USA
Page 2 of 2
SRF_Fill.pdf (PDF, 117.86 KB)
Use the permanent link to the download page to share your document on Facebook, Twitter, LinkedIn, or directly with a contact by e-Mail, Messenger, Whatsapp, Line..
Use the short link to share your document on Twitter or by text message (SMS)
Copy the following HTML code to share your document on a Website or Blog