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Please complete this form and fax it to the number listed above or mail it to the address at the end of this form.

NAME: ___________________________________________________________________________________ DATE: ___________________________________

ADDRESS: ___________________________________________________________________________ APT OR SUITE: ______________

CITY: ___________________________________________________ STATE: _____________________ ZIP CODE: __________________

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PARTS:

• FAX this form to place an order for part(s).
• FAX and SEND this form WITH part(s) for servicing with details on what is needed.

COMMENTS: _______________________________________________________________________________________________________________________

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ENGINE TUNER KIT ORDER:

Description: _________________________________________________________ QTY ___________ Price (per Kit): $ _________________

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SERVICE ORDER:

__________ SUSPENSION REBUILD__________ PORTING __________ MILLING _________ SPLITTING CASES __________ CARB BORING

__________ BLUE PRINTING _________ ENGINE REBUILD __________ OTHER

COMMENTS: _______________________________________________________________________________________________________________________

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RESTORATION: SPECIAL ORDER ONLY ~ PLEASE CALL WITH DETAILS

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U.S RETAIL PRICES ~ We accept PAYPAL, VISA, MASTERCARD and DISCOVER

Method of Payment:

Please select one: __________________ PayPal __________________ VISA _________________ MasterCard _________________ Discover

Credit Card Number: __________________________ Exp. Date (mo/yr): _______________ Security Code (on back of card): ___________