SERVICE FORM 

Please wash components thoroughly and remove guides, guards, cables etc. prior to shipping.   Wrap components to protect from contact. 

Rider & Motorcycle Information

Rider Name:_____________________________    Dealer Name:_________________________

Motorcycle Make: ___________________    Model:__________________    Year:______________ 

Shipping Information Select by Circling One*:     FedEx Ground     Three-Day     Two-Day     Next-Day Ship

*If no selection is made, Fedex Ground will be your default shipping method

To:____________________________________________________________________   Street Address:______________________________________________________________ City:___________________________    State:___________________    Zip:________________

Phone:____________________________ Email:____________________________________ 

Engine Service Item(s) Sent: Complete Engine   Head   Cylinder   Ignition   Carburetor    Transmission

Work to be Performed: _________________________________________________________________________________________________________________________________ ___________________________________________________________________________

Suspension Service Item(s) Sent:    Shock            Fork

Rider Ability Level:________________Type of Riding:_______________Terrain: __________

Rider Weight Without Gear:_____________________________________________________  

Work to be Performed:_______________________________________________________________________________________________________________________________ ________________________________________________________________________________

Billing Information

Name on Card:__________________________________Phone:_______________________

Type of Card:      Discover       Visa       Master Card       American Express

Credit Card Number: __________________________________________________________ Three Digit Code:______________________

Expiration Date: __________________________

Special Notes or Comments ___________________________________________________________________________ ___________________________________________________________________________

Contact us directly with any questions at 281-554-7333

EBR Performance Service Department

220 W Main

League City, TX 77573