First Name or if shipping to Business: ________________________________________Date ____________
State (print out):_________________________________ Zip Code:_____________
Shipping Address: Business____ (OR) Residential____
Vehicle Make:________________________ Year_________
Engine Size________ Carburetor Type: (If Known)_______________
Contact if extra minor work is needed:______ Contact only if extra work would exceed:$_________
Shipping Insurance (recommended :Y____) (Default:N____) UPS charge app. $1.00 per $ 100.00 Merchant is not be responsible for lost or damaged packages . We advise you to purchase shipping insurance.
We are not responsible for any packages left outside our business while business is closed.Packages can be stolen or miss delivered.. Make sure you request a signature for your packages shipped to us.
Release with out signiture:(Y____) (Default:N____)
Amount of insurance coverage $______ (Default $500.00)
Warranty: 6 month____ Lifetime____
Custom Rebuilding and Restoring