In order for us to best assist you please fill out this form completely.

NAME

BUSINESS NAME

ADDRESS

CITY

STATE ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANNA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING NONE

ZIP CODE

YOUR ADDRESS IF YOU RESIDE OUTSIDE OF THE U.S.A.

DAYTIME PHONE

EVENING PHONE

E-MAIL ADDRESS

HOW DID YOU HEAR ABOUT US ? FRIEND ONLINE SEARCH CAR CRAFT CHEVY HIGH PERF SUPER CHEVY HOT ROD STREET RODDER ROD & CUSTOM TRUCKIN' SPORT TRUCK CUST & CLASSIC TRK CLASSIC TRUCKS FOUR WHEELER 4WHEEL & OFF ROAD OFF ROAD SUPER ROD OTHER

WHAT ARE YOUR EXPECTATIONS?

HOW MUCH HORSEPOWER? 300-350HP 350-400HP 400-450HP 450-500HP 500-550HP 550-600HP 600-650HP 650-700HP 700-750HP 750-800HP 800-850HP 850-900HP 900-950HP 950-1000HP 1000 or More

DO YOU PERFER A CHEVY SB CHEVY BB

DO YOU PERFER A CARB EFI EITHER

WHAT IS YOUR BUDGET? $3-4000. $4-5000. $5-6000. $6-7000. $7-8000. $8-9000. $9-10000. $10-11000. $11-13000. $13-15000. $15-20000. $20000 & UP

WHAT TYPE OF VEHICLE?

YEAR 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 MAKE Acura Alfa Romeo AMC Audi Bentley BMW Buick Cadillac Chevrolet Chrysler Crosley De Soto Dodge Eagle Edsel Ferrari Fiat Ford Frazer Geo GMC Henry J Hillman Honda Hudson International Jaguar Jeep Kaiser Land Rover Lexus Lincoln Mazda Mercedes Mercury Merkur MG Mitsubishi Nash Nissan Oldsmobile Opel Packard Peugeot Plymouth Pontiac Porche Rambler Renault Rolls Royce Saab Saturn Studebaker Subaru Sunbeam Suzuki Toyota Triumph Volkswagen Volvo Willys

MODEL

VEHICLE WEIGHT ? 1000-1500 1500-2000 2000-2500 2500-3000 3000-3500 3500-4000 4000-4500 4500-5000 5000-5500 5500-6000 6000-6500 6500-7000 7000-7500 7500-8000 8000-8500 8500-9000 9000-9500 9500-10000 10000 & UP

CURRENT ENGINE ? SMALL BLOCK CHEVY BIG BLOCK CHEVY OTHER NONE

WHAT IS YOUR APPLICATION ? DAILY DRIVER STREET STREET/STRIP STREET ROD WEEKEND WARRIOR TOW VEHICLE SHOW CAR RACE ONLY MARINE

DO YOU HAVE A TRANSMISSION ? I HAVE ONE I NEED ONE

WHAT TYPE? ? POWERGLIDE TH-200 TH-250 TH-350 TH-375 TH-400 200-R4 700-R4 4L60E 4L80E 3-SPEED MAN 4-SPEED MAN 5-SPEED MAN 6-SPEED MAN OTHER

DO YOU HAVE A STALL CONVERTOR ? I HAVE ONE I NEED ONE

WHAT TYPE? ? 1500-2000 2000-2500 2500-3000 3000-3500 3500-4000 4000-4500 4500-5000 5000-5500 5500-6000 6000-6500

CURRENT GEAR RATIO ? 2.73 3.08 3.23 3.42 3.54 3.55 3.73 3.75 3.90 3.91 4.10 4.11 4.30 4.56 4.57 4.86 4.88 4.89 5.13 5.14 5.38 5.57 5.86 6.14 OTHER

ARE YOU WILLING TO CHANGE? YES NO

REAR TIRE DIAMETER ? 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 OTHER

WHAT ARE YOUR FUEL REQUIREMENTS? ? 89 OCTANE 92 OCTANE RACING FUEL

DO YOU PLAN TO USE AN NOS SYSTEM? NO MAYBE YES

HOW MUCH NOS HP? 0 0-50 50-100 100-150 150-200 200-250 250-300 300-350 350-400 400-450 450-500 OTHER STAGES NONE 1 2

DO YOU PLAN TO USE A BLOWER? NO MAYBE YES

WHAT SIZE AND MODEL?
HOW MUCH BOOST?

DO YOU HAVE NEED HEADERS?

PRIMARY TUBE DIAMETER ? 1 5/8 1 3/4 1 7/8 2 2 1/8 2 1/4 2 3/8

DIAMETER OF EXHAUST SYSTEM ? 2.00 2.25 2.50 2.75 3.00 3.25 3.50 3.75 4.00 4.25 4.50 4.75 5.00

EMISSIONS LAWS, RULES OR RESTRICTIONS IN YOUR AREA?

MODIFICATIONS TO THE VEHICLE?

COMMENTS

WHEN DO YOU PLAN TO PURCHASE AN ENGINE ? NOW 2-4 WEEKS 1-2 MONTHS 3-6 MONTHS 6-12 MONTHS 1-2 YEARS 2 YEARS