Airbagit Wheel Adapter and Spacer - Manual (Page 2)

WHEEL ADAPTER ORDER REQUEST
Airbagit.com Suspension LLC
260 S. Hibbert Street
Mesa, AZ. 85210
Phone 800‐842‐8789
Fax 480‐898‐9049
Page 1 of 1
SHIPPING INFORMATION (Please Fill Out As Complete As Possible, Please Print Clearly.)
Name
Company Name
Street Address
City, State, Zip
Daytime Phone
VEHICLE INFORMATION
Year Make Model Wheel Lug Count
CREDIT CARD INFORMATION
Cardholder Name Account # Expiration Security Code
WHEEL ADAPTER ORDER REQUEST
HUB SIDE
Bolt Pattern Center Bore
WHEEL SIDE
Bolt Pattern Center Bore
WHEEL ADAPTER OPTIONS
Thickness Stud Choice
I authorize ASAPairparts.com to charge my credit card for this order. I hereby state I am authorized to use the credit card on this
order. In the event I return an item on this order I understand there will be a 35% restocking charge for doing so.
Signature: __________________________________________________________ Date: __________________________