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Customer Information

Company (required*)

Address*

City, State, Zip*

Your Name*

Title/Position*

Phone*

Email*



Vehicle Information

Fleet Number

Year

Make

Model

Body Type

Bed/Box Length

Color

VIN

Hours/Mileage

License Plate

GVWR (lbs.)

Fuel (Type/Cap)



Engine Information

Year

Make

Model

Liters

Cylinders

Horsepower

Torque

EIN

RPM's

PTO (RPM's)



Vehicle Emission Control Information

Conforms to Regulations Number

U.S. EPA Number

On-board Diagnostics (OBD) Number

Fuel Type

California Emissions

Engine Group Number

Evaporative System Number



Alternative Fuel System Information

Fuel Type

System Type

Injection Type

Tank Manufacturer

Tank Catalog Number

Tank Type (Bed/Box Mount, Manifold, Slick, etc.)

Tank Capacity

Tank Size (Diameter x Length x Width)

Tank Weight (Empty)

Tank Serial Number

Remote Fill Location

Tank Mounting Location

Notations

Customer Information

Company (required*)

Address*

City, State, Zip*

Your Name*

Title/Position*

Phone*

Email*



Application Information

Equipment

Year

Make

Model

S/N

Weight

Hours

Weight Load



Engine Information

Year

Make

Model

Weight

S/N

Engine Type

Rated Power

Rated Torque

Fuel Type/Cap

Oil Capacity

EPA Number

Cycle(s)

Cylinders

Displacement

Bore x Stroke

Compression Ratio

Orientation

Cooling System

Air Cleaner

Ignition Type

Start Method

Usage



Alternative Fuel System Information

Fuel Type

System Type

Injection Type

SystemType

Adaptor, Custom Carburetor or Spud Tube

Tank Size

Tank Weight (Empty/Full)

Tank Fuel Capacity

Tank Mounting (Brackets & Location)

EPA-Certified or Non-EPA-Certified System



Accessories/Options

Desired Hose Length

If electric start, would you like a 12-volt fuel shut-off safety solenoid?

If recoil start, would you like a vacuum-controlled fuel lock-off safety solenoid?

If remote air cleaner, would you like an automatic primer?

Notations