Ship To: Duffield Cycles 11186 Welsh Run Rd. Greencastle PA 17225

Axle Repair Order fill out and send with your parts

Make___________________________________________________________________________________

Model___________________________________________________________________________________

Size____________________________________________________________________________________

Year____________________________________________________________________________________

Placement of axle you are sending-   LR, RR, FR, FL (circle one)

Name___________________________________________________________________________________

Address__________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Phone_________________________________________Cell_______________________________________

Email____________________________________________________________________________________

Description of work to be done_________________________________________________________________

_________________________________________________________________________________________

________________________________________________________________________________________

Other Notes_______________________________________________________________________________

________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Ship your parts to the address above, when we receive your parts we will make and inspection of the parts and call or email you with a quote to repair.

Billing information will be handled when we call you with the quote. VISA/MC/Money Order/Checks must clear with bank before shipment but are accepted.