Contact Name________________________________Work Phone_________________________

Company Name______________________________Home Phone_________________________

Address____________________________________Apt/Unit #__________________________

City___________________________________State_____________ Zip__________________

Use of Vehicle

Street ________________%Towing__________________RV_____________________

Drag Strip %__________________1/4 Mile________1/8 Mile________Off Road ____________%

Circle Track______________________Track Size_________Mile Dirt_______Asphalt________

Car_____________________Make________________Model_____________Weight____________

Engine Size______________Cu. In. HP.____________Comp. Ratio__________________

Bore_________Stroke_________Rod Length_________ Valve Size: Intake_______Exhaust________

Cylinder Head Type_____________________________ Comb. Chamber C.C's______________________

Cam Make___________________Number____________ Duration at .050: Intake______Exhaust_______

Hydraulic or Solid_______________________Roller or Flat Tappet____________________________

Lobe Center: Intake__________Exhaust___________Seperation_____________________

Valve Lift: Intake_________Exhaust________ Rocker Arm Ratio: Intake________Exhaust_________

Ignition Make___________________________Box #__________________Is Adv. Locked Out Y / N

Crank Trigger Y / N

Intake Manifold Make____________________Model____________________Port Work Y / N

How Many Spacers?_________________Bolt Pattern 850___________Dominator______________

Describe Exhaust System_________________________________________________________________

Gear Ratio_______________________________Tire Size_________________________________

Transmission Make_______________________Gear Ratio_________________Trans. Brake Y / N

Torque Converter Make____________________Stall Speed__________________

1st Step R.P.M.______________Shift R.P.M.________________Max R.P.M.__________________

Does car use thottle stop?______________________________Brand___________________

Fuel Pump____________________________Fuel Regulator__________________________