Name:__________________________________________________________________________

Address : Street _________________________________________________________________

City______________________________________  State _______  Zip _______________

Country ___________ Additional shipping info __________________________________________

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Home Phone _____/_____/_____    Work Phone _____/_____/_____ Cel Phone_____/_____/_____

Email____________________________________  Payment Method:  Check or money order enclosed_____ Pay Pal _____ Cod_____

Please describe in detail any and all modifications, drawings will help.

Example: (Modify front of pan to allow for stretched tanks, mark on pan or provide template photos with measurements always help.)

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Please check if  additional pictures were provided ._______

Please describe in detail. Drawings and photos help.

Example: (Please add gel to front and rear of seat, or I would like a 3" push on the rear of my seat and end the front at 1/4 ".

Please check t/  Gel for front rider _____  Gel for Rear Passenger ____  Heat seat front____ Heat seat rear____

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Please check if  additional pictures were provided ._______

Please describe in detail. Drawings and photos help.

Example: (I would like my seat wrapped in black leather with black stitches...)

Materials___________________________                     Thread Colors_______________________________

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