
Supercharger Rebuilder
26988 SE Hwy 19 Unit #47 Old Town, FL
32680
PO Box 186 Old Town, FL 32680
352-542-0147 Fax: 352-542-9468
superchargertechnologies@yahoo.com

(This form must be completed a shipped back with
core to receive refund)
This form will be included in the shipment with your new
supercharger!
Name:______________________
Company_______________________
Address:________________________________________________________
City:_____________________ State:____________
Zip:____________
Phone:__________________________
Fax:____________________(
optional)
Vehicle Information
Manufacturer:____________________
Model:___________________________
Year:________ Engine:_____________
Mileage:_________________________
Complaint: Reason for replacement
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
26988 SE Hwy 19 Unit 47
PO Box 186
Old Town, FL 32680
352-542-0147
352-542-9468 (Fax)
(Click)
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