Please either print this page, fill in the details and send it with your cylinder

or print this .pdf file

or fill out this online form so we know what to do with your cylinder when it arrives. Please don't forget to put your name on your cylinder so we can confirm that it is yours.

 

workorder nz

Please print out and complete.  Pack this with your cylinder and send to:
NZ Cylinders, 210 Wills Street, Ashburton, 7700 New Zealand


Address/Contact Details
Name:   ........................................................................................................................................
Company:.....................................................................................................................................
Date:      ........................................................................................................................................
Postal Address:.............................................................................................................................
City/Town:.....................................................................................................................................
Phone:……………………………………………… Fax:………………………………………….
Email:………………………………………………..

Cylinder Information (Please remove studs, powervalves, and fittings)
Make:    ........................................................... Model:.................................................................     
Year:      ...............    Frame number………
We require piston is it included:  Yes / No
If No do you want us to supply one:  Yes / No
We require all studs, power valves etc to be removed. There will be an extra charge if you would like us to do this. Please send the power valve with the cylinder so we can check fitment after plating.
Any special instructions for this cylinder:  Yes / No
Describe: ......................................................................................................................................
......................................................................................................................................................     
......................................................................................................................................................
......................................................................................................................................................

Payment Method
Credit Card (Circle One):       Visa       MasterCard
Card #:..........................................................................................................................................
Exp. Date:................................................   
Card Holders Name:.....................................................................................................................
(Will advise on pricing before payment is made)
Direct Debit Account:  Y / N
Westpac
DG ENGINE SERVICES
030835  0252003  00

Address Label For Your Use

...................................................................
            

            
NZ Cylinders   
210 Wills Street
Ashburton 7700

New Zealand


Sender:..........................................................................
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