Customer Form

9632 Humboldt Ave S, Bloomington MN 55431
877-856-7103 or 952-881-7095
SPEEDOMETER AND GAUGE REPAIR, RESTORATION AND SALES
AUTHORIZED DISTRIBUTOR OF THE COMPLETE LINE OF SMITHS INSTRUMENTS

SERVICE INFORMATION FORM

(COMPLETE & INCLUDE WITH SHIPMENT)

Your Name ____________________________________________________________________________________________________________________

Address ____________________________________________________________________________________________________________________

Email _________________________________________________________Phone______________________________________________________

Year/Make/Model ________________________________________________________________________________________________________________

Volts (6 or 12) ___________________________________________________________________________________________________________________

Describe work you want done ________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

Include any previous correspondence you have had with APT about this job. See our S&H tips before packing and sealing.

Ship to (we recommend UPS or FedEx):

APT Instruments, 9632 Humboldt Ave S, Bloomington MN 55431

952-881-7095

We accept Visa, MasterCard, Discover, American Express, money orders and checks. Dealer purchase orders are accepted with prior approval.

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Last modified: June 23, 2010