C Cycle Rider Input and Quote Form

Rider Input & Quote Form

*Note: This is an unsecured form, do not click the submit button if credit card info is filled out. Print the form and include when shipping your components.*
Rider name
Weight w/o gear	Height
Shipping address
City	State
Zip Code
Home phone (include area code)
Work/day phone (include area code)
(Necessary to ensure we can contact you if there are any questions during service.)
E-mail
Referral Source

Bike year	Brand
Model	Size
Primary type of riding
Ability	Typical Finish

Fork Service: revalve rebuild oil change other
Fork Products: anti-bottoming system internal bleed springs Ultra Adjusters
Fork Mods: hard coat anodize internals titanium nitride legs shorten travel

Shock Service: revalve rebuild oil change other
Shock Products: heavy duty bumper ultra adjuster spring
Shock Mods: hardcoat anodize titanium nitride shaft shorten travel

Payment method: cash check COD credit card
Credit Card Payment: Card # Exp
Shipping:	Shipping rate:

Comments:

SHIP TO: C-Cycle Suspension Service 16 West High Street East Hampton, CT 06424