Sales confirmationChristian Nelson2024-04-07T13:12:22+00:00 Please enable JavaScript in your browser to complete this form.Customer Information_______________________________NameEmailPhone___________________________________________________________________________________________________________________Shipping Address Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryFreight Charges *Will you require a Liftgate Truck to YesNoInternational Customers Air FreightOcean Freight___________________________________________________________________________________________________________________Details of Current Vehicle Current Year Current Make Current Model Current EngineCurrent Transmission *ManualAutomaticAdditional Notes___________________________________________________________________________________________________________________New Order DetailsEngine / HP302 / 350 HP331 / 415 HP347 / 425 HP363 / 500 hp351w / 410 HP408W / 475 HP427W / 538 HPOtherIf Other Please MentionTransmission Type.C4 AutoAOD4r70w5 speed T5TKXT56 6 SpeedOtherIf Other Please Mention Carbureted or Fuel InjectionEngine Color *RedBlueBlackYellowCustom Color (Mention in Additional Comments)If Other Please MentionIgnition Wire Color *RedBlueBlackYellowCustom Color (Mention in Additional Comments)If Other Please MentionOil Pan Configuration *FrontRearOil pan TypeSerpentine Pulley Options *Alternator onlyAlternator and Power SteeringAlternator and AC CompressorAC, Power Steering and AlternatorValve Cover TypeChromePolished Ball MilledBlue Powder CoatedRed Powder CoatedBlack Powder CoatedCobra LogoOther (Please Specify)For Valve Color Please specify if you have selected otherWater Pump Inlet *Drivers SidePassenger SideAir Cleaner TypeAdditional Polished OptionsFuel Line Type Include StarterYesNoPurchasing a Transmission ? YesNoTransmission TypeAutomaticManualIf Automatic. Converter Stall Range ?2200 - 26002400 - 28002800 Or HigherGear Ratio Tire SizeIf Manual *Cable OperatedHydraulicNOTE: If switching from an Automatic will require a pedal , among other things.Speed *5 Speed6 SpeedTotal Price with ShippingAdditional Notes ___________________________________________________________________________________________________________________Add on OptionsCheckbox ItemsSTANDARD FLYWHEEL / Pilot Bushing - Steel Billet 157 tooth. Zero Balance or 28 oz. - $390.00Starter - For 157 or 164 tooth Flywheel - $259.00Cobra Valve Cover - M-6582-A - $225.00Cobra Air Cleaner M-9600-C302 - $199.00Ford Racing Powder Coated VC / Air Cleaner - $350.00Braided Fuel Lines - $250.00Steel Bellhousing - $1,199.00Aluminum Bellhousing - $800.00Clutch Kit - $995.00Canton Oil Pan - $599.00Sniper EFI 2 - $2,350.00Option # 1 Pulley Kit. Alternator Only - $990.00Option # 2 Pulley Kit. Alternator and Power Steering - $1,990.00Option # 3 Pulley Kit with AC and Alternator - $2,190.00Option # 4 Pulley Kit. AC, Power Steering and Alternator - $2,595.00Clutch Equalizer Bracket - $225.00Power Steering Pressure Reducer Fitting - $195.00Hydraulic Clutch Slave External - $699.00___________________________________________________________________________________________________________________Other Alterations that may affect engine install ?Do you plan on adding AC Later onYesNoIf Yes suggest a Serpentine Pulley Waraptor Kit. *Does Vehicle have a Hood Scoop or planning one YesNoPlanning on running with Shorty, Mid Length or Long Tube Headers ?ShortyMidLongFactory Suspension -Coil Over Heidts, TCI Suspension or Other? Coil OverHeidts, TCI Suspension or OtherAny Modifications to Vehicle - Relocating of crossmember for Oil Pan ? YesNoIs this a standard US Driver side vehicle or Right hand Driver YesNoComment or Message ___________________________________________________________________________________________________________________Submit
