| ORDER INFORMATION: |
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| Name (First and Last): * |
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| Your Title: |
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| Company Name: |
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| Address: * |
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| City: * |
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| E-mail Address: * |
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| State: * |
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| Zip: * |
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| Phone #: * |
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| Fax Number: |
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| Website Address: |
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| Type of Business: * |
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| ENGINE: |
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| Engine Make: * |
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| Engine Size: |
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| Finished Bore: * |
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| Stroke: * |
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| Rod Material: * |
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| Rod Length: |
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| Head Gasket Thickness: |
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| Block Height: |
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| Deck Clearance: * |
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| APPLICATION: |
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| Application: * |
Gas
Alcohol
Carb
Injected
Nitrous, # & size shots or est hp
Blown, lbs boost
Turbo, lbs boost
Drag
Oval
Puller
Boat
Street/Strip |
| Additional Information / Other Application: |
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| PISTONS: |
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| Pistons: * |
Flat Top
Dome
Reverse Dome
Full Dish |
| Piston Dome CC's |
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| Piston Dish CC's |
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| No. of Pistons ordered: * |
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| No. of Cylinders in Motor: |
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| Compression Height: |
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| Desired Compression Ratio: |
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| Top Ring Thickness: * |
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| & Radial Width: |
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| Second Ring Thickness: * |
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| & Radial Width: |
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| Oil Ring Thickness: * |
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| & Radial Width: |
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| Does job need oil rail ring? * |
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| Does job need Buttons? * |
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| PINS: |
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| Pin Diameter: * |
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| Pin Length: * |
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| Pin Type: |
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| Provide Pins* (Standard Pins Included) Others extra: |
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| Pin Fit: * |
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| Pin Locks: * |
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| We supply locks? * |
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| HEADS: |
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| Head Make: * |
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| Head Model: |
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| Chamber CCs: * |
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| Head Milled: |
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| VALVES: |
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| Intake Valve Diameter: |
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| Intake Valve Lift: |
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| Intake Valve Duration: |
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| Exhaust Valve Diameter: |
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| Exhaust Valve Lift: |
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| Exhaust Valve Duration: |
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| OPTIONS: |
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| Coatings: |
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| Gas Ports: |
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| Special Instructions: |
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| * Required |
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