Request Form Name: E-mail: Repeat E-Mail Address: Phone: Postal / Shipping Address: Postal / Shipping Address 2: City: State / Province: Postal / Zip Code Country Application Type Please select oneAutomotiveMarineIndustrial/Farm Equipment Make Model Year Air Conditioning? YesNo Please select oneAutomaticManual Please select oneCaliforniaFederal / CanadaNot ApplicableDon´t Know Engine Information Engine Size (CID or liters) # Cylinders: 8 Cyl.6 Cyl.4 Cyl.Other: (please explain under information requested)Don't KnowEngine is stockEngine is modified: (Please explain under "Information Requested." If you have an aftermarket manifold, tell us whether it is spread-bore or square bore.) How is your vehicle used Stock / Daily UseOff-RoadTowingHigh AltitudeStreet PerformanceRacing Only: (please explain under information requested) Carburetor Type(s) 4 Barrel2 Barrel1 BarrelDon´t Know Other: 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 disconnect your battery terminals and change fuel & air filters when a new or rebuilt carburetor is installed.
