Contact Us

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Name	____________________________	Am. Speed Engine	____________________________
Street address	____________________________	Cubic Inch	____________________________
Address (cont.)	____________________________	Horsepower	____________________________
City	____________________________	Eng. Paint Color	____________________________
State/Province	____________________________	Type of Vehicle	____________________________
Zip code	____________________________	Year	____________________________
Work Phone	____________________________	Transmission	____________________________
Home Phone	____________________________	Rear end ratio	____________________________
FAX	____________________________	Converter size	____________________________
		Base price	$____________________

Optional Equipment
	$
	$
	$
	$
	$
	$
	$
	$
	$
	$
	$
	$
	$
	$
Turnkey Option	$
Total	$
Sales Tax (IL)	$
50% deposit	$
Crating & Handling ($65.00)	$
Overseas ($75.00)
Balance

All orders require a 50% deposit. Personal checks require 2 weeks to clear. All secured orders are non-cancellable and non-refundable after 7 days. Remitting of a security deposit is with the understanding that customer accepts our terms and warranty.

Method of Payment: __ Personal Check __ Money Order __ Cashiers Check
__Visa __MasterCard __Discover

Card # _______________________ Exp. Date: _________________ Name on Card: _______________________

CompanyLongName 3006 Ave of the Cities CompanyCityStateZip Telephone: CompanyPhone FAX: CompanyFAX

CompanyLongName
3006 Ave of the Cities
CompanyCityStateZip
Telephone: CompanyPhone
FAX: CompanyFAX