Stainless Steel Impeller Service Order Form


Print Form


Name:___________________________________________________________

Billing Address:_________________________________________________

City:_____________________________ State:_______________ Zip:________

Dayime Phone:(____)_____________ Evening Phone:(____)________________

Shipping Address (if Different from Billing)_____________________________________

City______________________________ State:_______________ Zip:________

Email Address : ____________________________

Please bill my: (Optional)
Visa Master card Discover  Amex C.O.D. Call me for payment

Card Number: ___________________________________ Exp. Date:_________

Signature: __________________________Last 3 digits from back of card______

Please return-ship package (UPS): Ground 3-Day 2-DayOvernight

U.S.P.S

List Description of Impeller(s) Sent: ____________________________________
_________________________________________________________________
_________________________________________________________________

Description of Service Requested: ______________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Additional parts requested (ie- impeller tool, pump oil, nose boot/seal etc.):_________

_________________________________________________________________
 

  Print, fill out and mail this form along with your Impeller(s) to:
IMPROS Impeller Performance

38959 Cherry Estates Circle Cherry Valley, CA 92223

(951) 737-2900

Undeliverable, refused, or unclaimed packages will become the property of Impros after 90 days. 
All serviced impellers will be shipped via UPS ground service unless specified otherwise.