INFORMATION FORM

Name:

Company:

Phone:

Fax:

E-Mail:

Address1:

Address2:

City:

State:

Zip:

Address is: Home
Business

Boat Information:

Make:

Model:

Year:

Engine/Carburetor Information:

Engine Size/HP:
(CID, Liters & HP)

Number of
Cylinders: 8 Cyl. 6 Cyl. 4 Cyl.

Carb Number:

Model Number is found on metal tag or is stamped on carburetor body.

Additional Information about your Carburetor:
If ordering an exchange carburetor, put information for choke type, linkage type, and gas inlet type. Refer to Carburetor Catalog page if you have any questions as to what these items are.

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