Inquiry / Order*

INQUIRY ORDER

Re.*

SPARE PARTS PATRIOT ITEMS RIMS / WHEELS TRAILER HITCH VEHICLE CLASSIC CAR ENGINE TRANSMISSION REPAIR OTHER

PERSONAL INFORMATION

Last Name*

First Name*

Address*

City*

ZIP*

State*

Country*

phone

fax

e-mail*

VEHICLE INFORMATION

VEHICLE ID# (VIN)*

SORRY, NO ANSWERING ON                                                                             PARTS REQUESTS W/O VIN !!!

Year*

Make*

Model*

Style*

4-door Sedan (with post) 4-door Hardtop (w/o post) 2-door Sedan (with post) 2-door Hardtop (w/o post) 2-door Coupe 2-door Convertible SUV PICK UP VAN OTHER

# of Doors*

2 4 5 OTHER

cid/cui or ccm/litre*

# of Cylinders*

4 6 8 10 12 OTHER

Transmission*

Manual Transmission Automatik Trans Others

Trans Type (i.e. TH400)

Drive Type*

Front Wheel Drive (FWD) Rear Wheel Drive (RWD) 4-Wheel Drive (4WD)

Disc Brakes

front   rear

Drum Brakes

front   rear

Power Steering

Air Conditioning

Carburetor

1bbl   2bbl  4bbl  fuel injection

Description

Comments /
Others