SRF Fill .pdf

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Original filename: SRF_Fill.pdf
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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


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