Jeep / AMC / Isuzu / Mitsubishi Cylinder Heads. On line order form

State/Province

Zip/Postal Code

Refundable Core deposit

Illinois Residents only add 7% Surcharge includes EPA and sales tax

Gas Cylinder Head Shipping: each way $15 Residents of CA, OR, WA, ID, NV, UT, MT, AZ $20 each way

Total up front payment for each head

From the chart above Cylinder Head Price

Name:

Address:

Phones

E-mail:

State/Prov:

Zip/Postal Code

City:

Country:

Deliver

the

Heads

To:

Business / Name

Country

Residential or

Business Address

E-mail address

Contact Person

Phone

Methods of Payment / Pick one

Walk-in-Cash

Wire Transfer from your checking account
Go to your personal banker and tell them to send a wire transfer for the amount total above to Remanufacuterd.com money in about three hours

Check / Money Order / Cashiers Check

In a hurry? Call UPS at 1-800-742-5877 for information on how to send a Cashier's Check / MO to Remanufactured at 14401 S. State St. Lockport IL 60441 (personal and company checks are delayed at least a week for clearing)

If you choose to order using this form you will also receive response and confirmation from a human by e-mail or phone . Although we have very good coverage, if we are out of stock on an item you have selected or if for some reason we can't ship within 3 days, you will be notified via e-mail or phone as to what the status is.