1 - Dirt-Tech
1. Ordered By:
|Name: | |
|Company Name: | |
|Mailing Address: | |
|Address (cont.): | |
|City: | |
|State/Providence: | |
|Zip/Postal Code: | |
|Country: | |
|Daytime Phone: |( ) - ext: |
|Fax: |( ) - |
|E-mail: | |
2. Payment Type:
Check COD Pre-Pay
3. Ordered for:
|Name: | |
|Company: | |
|P.O. # | |
4. Ship to Address: (leave blank if same as Ordered By:)
|Street Address: | |
|Address (cont.) | |
|City: | |
|State/Providence | |
|Zip/Postal Code | |
|Country: | |
5. Quantity:________________
6. Distance from tube-end To tube-end:________________
[pic]
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7. Lower Trailing Arm Bracket Centerline:__________________
[pic]
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*LOWER BRACKETS ARE 3in INSIDE WIDTH*
8. Circle for: Back Bracing Yes No
[pic]
9. Circle for: Upper Four-Link Brackets Yes No
[pic]
*UPPER FOUR LINK BRACKETS ARE 2in INSIDE WIDTH*
--Will accept up to a 1 ¼in Heim--
10. Upper Truss Yes No
If yes: Full length Half length (half length shown)
11. Tube Size 4 inches 3.5 inches
*Filler Bung Size is 2in and location is standard*
[pic]
12. Circle Vent Location / Size:
Ship Loose AN -6 AN -8
Standard Location AN -6 AN -8
*Housings are sold without Hub assemblies, unless other wise requested. Fully assembled rear-ends are available*
Custom Applications will be subject to additional Charges and Rates
Dirt-Tech will not be held responsible for any information NOT provided on order sheet, if there are special instructions, please call to verify.
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