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                Spencers Seat Mod Order Form
                       Please print and include a copy with your seat when shipped

 Name__________________________________________________Date__________________

 Shipping address_______________________________________________________________
                        
                        City____________________________State_______Zip_________

 Contact number_________________________________________Call between____am____pm

           E-Mail Address_____________________________________________________

          Year, make, model of bike_____________________________________________

 Riders seat modification:      YES    NO       Supracor "LD" upgrade on Riders Seat:  YES   NO
 Passenger seat modification: YES    NO       Is riders seat to be lowered:                   YES   NO
          
  Your Height_______Your weight_______Your pants inseam______Passengers weight______

 Do you use risers?  YES  NO     If yes, what is rise_____________and pullback_____________

                 What is your normal riding position?      Up on tank        Back on seat

 Special instructions:_______________________________________________________________
_______________________________________________________________________________

                Shipped with:        UPS        FedEx       USPS    ( I cannot return ship via DHL ) 

 Payment method:  ____ Money Order -  Make  payable directly to Frank S. Turnier
                           ____ Other__________________________________
                           ____ PayPal  (  to:  Spencersmotocare@aol.com  )         Total $___________

                      Please E-Mail BEFORE you ship your seat
 Return shipping costs are not included in your seat mod pricing.  It is highly recommended that
 you have your shipper include a prepaid return shipping label in the box with your seat when
 shipped.  This way you control the cost, return address, and will have your tracking number each
 way. Please see the FAQ page for more information.

               Ship to:   Spencers Moto Care          E-Mail:  Spencersmotocare@aol.com
                              C/o Frank Turnier
                              878 SW 36th Terrace         Phone: 772-418-9712                                
                              Palm City, FL  34990

 Thank you for letting me help you enjoy the ride, Spencer

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