Request Form for Pricing and Product Availability For all Automotive Carburetor and Fuel Injection Applications
Please fill out this form with all necessary information so that we can quote you with accurate pricing and product availability. Please indicate if you want your marine carburetor or fuel injection core rebuilt. We absolutely guarantee that this information will not be sold or used for any other purpose.

Name:
Company:
Phone:
Fax:
E-Mail:
Address1:
Address2:
City:
Stat:
   
Zip/+4:
Address is: Home
Business

Automobile Information:
Make:
Model:
Year:

Engine Information:
Make/Model:
Engine Size:
 (CID or Liters)
Number of
Cylinders: 		8 Cyl. 6 Cyl. 4 Cyl.
Other - Please explain in text box at bottom of form.
Don't Know
Engine is:
Stock
Modified - Please explain in text box at bottom of form.

Carburetor and Manifold Information:
Carburetor
Type:		 4 Barrel 2 Barrel 1 Barrel
Other - Please explain in text box below
Don't Know
Number of: Carburetors on Engine
   
Brand/Make:
   
Model Number:
  Model Number is found on metal tag or is stamped on carburetor body.
Rebuild My Carb Core: Yes
No
Intake
Manifold:		 Stock
After Market
If manifold is "After Market", is it?:
Spread Bore
Square Bore
Don't Know

Fuel Injection Information:
Type of Fuel Injection: MPI - Multiport Injection
TBI - Throttle Body Injection
Don't Know
MPI or TBI Model Number:
Rebuild My FI Core(s): Yes
No

Additional Information about your Carburetor or Fuel Injection:

Response Method Requested:
How do you want us to get back with you?
Phone
Fax
E-Mail
Letter - U.S. Post Office

Purchase Timeframe:
Immediately
1-2 Weeks
3-4 Weeks
2-3 Months
Not Sure

How did you find us?