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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       DHL    Other

Payment method:  ____ Money Order (Make payable to Frank 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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