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
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 ---CNGLPGLNG
System Type ---Bi-FuelDual-FuelMono-Fuel
Injection Type---LiquidVaporized
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
Application Information
Equipment
S/N
Weight
Hours
Weight Load
Engine Type
Rated Power
Rated Torque
Fuel Type/Cap
Oil Capacity
EPA Number
Cycle(s)
Displacement
Bore x Stroke
Compression Ratio
Orientation
Cooling System
Air Cleaner
Ignition Type
Start Method
Usage
Fuel Type ---LPGNGBoth
System Type ---DedicatedBi-FuelTri-Fuel
SystemType---High PressureLow Pressure
Adaptor, Custom Carburetor or Spud Tube
Tank Size ---20 LBS33 LBS43.5 LBS
Tank Weight (Empty/Full)
Tank Fuel Capacity
Tank Mounting (Brackets & Location)
EPA-Certified or Non-EPA-Certified System---EPA-CertifiedNon-EP-Certified
Accessories/Options
Desired Hose Length
If electric start, would you like a 12-volt fuel shut-off safety solenoid? ---YESNOUnsure
If recoil start, would you like a vacuum-controlled fuel lock-off safety solenoid? ---YESNOUnsure
If remote air cleaner, would you like an automatic primer? ---YESNOUnsure
