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CARBURETORS
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YOUR INFORMATION
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Name
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Postal / Shipping Address
Postal / Shipping Address 2
City
State / Province
Postal / Zip Code
Country

APPLICATION TYPE

Make
Model
Year

Air Conditioning? Yes No

Transmission

Emissions Requirements

ENGINE INFORMATION

Engine Size (CID or liters)

# Cylinders:
8 Cyl.
6 Cyl.
4 Cyl.
Other: (please explain under information requested)
Don't Know
Engine is stock
Engine is modified: (Please explain under "Information Requested." If you have an after-market manifold, tell us whether it is spread-bore or square bore.)

HOW IS YOUR VEHICLE USED
Stock / Daily Use
Off-Road
Towing
High Altitude
Street Performance
Racing Only: (please explain under information requested)

CARBURETOR TYPE(S)
4 Barrel
2 Barrel
1 Barrel
Other:
Don't Know
Number of carburetors on engine (if more than one):
Brand of Carburetor(s):
Carburetor # (Important if requesting rebuild kits or repair parts. Number is found on metal tag or is stamped on carb body)

INFORMATION REQUESTED

ATTENTION: Always disconect your battery terminals and change fuel & air filters when a new or rebuildt carburetor is installed.

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