SHOCK REBUILD FORM
Name:					Date:
Address:
City:			State:		Zip Code:
Phone:				E-Mail:
Fax:
Work Request:
Number of Shock:					Date need By:
Special Valving:					(Exp: 3 comp /4 reb or 30 reb / 40 comp)
Ship To:
			BSB MFG INC
			20 INDUSTRIAL AVE
			WELLINGTON KS, 67152