New Carburetor/Modifications/Rebuild Spec Form
You can either use your keyboard to complete this form online and then print it, or print it first
and complete it manually. Send the completed form with your component/part to:
C&S Specialties, 3528 Highway B, St. Charles, MO 63301

SERVICE REQUESTED:    New Carb     Rebuild     Modification
No. of Cylinders:
Engine Type (Ford, Chevy, etc.):
Cu. In. Displacement:
RPM (Max):    RPM (Min):    Fuel Type:
Cam Type: Roller     Hydraulic     Flat    
Cam Lift (I):     Cam Lift (E):    
Cam Duration (I):     Cam Duration (E):
Lobe Separation:     Heads (Degree):
Transmission: Auto    Stick    Stall:    Rear Gear:
Supercharger: Roots     Screw     Centri     Turbo
Boost (PSI):     Blowthru     Drawthru
NOS (1st):     (2nd)     (3rd)    
Type of Racing (check all that apply):
Drag Race     Circle Track     Puller     Hill Climb     Super Speedway
Road Race     Short Track     Asphalt   Other
Track Size:     Car Weight:     Tire Size:
Work Description/Comments:
Date Needed By:
State:       ZIP:
Day Phone:
Eve Phone:
UPS Shipping: Ground     3-Day     2-Day     1-Day
Credit Card:
VISA MasterCard Discover
Expiration Date:
Card No.:
Three-digit ID (on back of card)