USE THIS QUESTIONNAIRE TO AID YOU IN MAKING YOUR ENGINE PARTS ORDER OR
RETURN TO US & WE'LL USE YOUR ANSWERS TO CREATE AN ORDER FOR YOU &
RETURN IT TO YOU FOR YOUR APPROVAL.
PLEASE PRINT AND FILL OUT, OR CUT AND PASTE TO A WORD DOCUMENT AND FILL OUT
ALL THE FIELDS AND EMAIL IT TO US. YOU MAY ALSO MAIL OR FAX THE FORM TO US, THANKS.
1-YEAR OF CORVAIR______ 2-HORSEPOWER______ 3-AIR CONDITIONING YES_____ NO_____
YEAR OF ENGINE_______ # OF CARBS______ KEEP FACTORY SMOG YES_____ NO_____
HEAD NUMBER ________________ (7 DIGITS REQUIRED, SEE THE BOTTOM OF PAGE 1 IN OUR MAIN CATALOG)
BLOCK CODE? __________ (SEE THE BOTTOM OF PAGE 1 IN OUR MAIN CATALOG)
4-GENERAL PERFORMANCE LEVEL YOU DESIRE__________
GIVE US A NUMBER BETWEEN #1-5
#1=STOCK
#3=ABOUT MAXIMUM FOR "PERFORMANCE STREETABLE"
#5=MAXED OUT PERFORMANCE.
(YOU CAN ALSO USE + OR -, 3-)
5-ENGINE ROTATION- REGULAR CORVAIR ____
REVERSE ROTATION (VW OR SPECIAL APPLICATION) ____
6-APPROX RANGE OF $ YOU WANT TO SPEND $__________ - $__________
CHECK OFF THE FOLLOWING. NUMBERS IN PARENTHESES NEXT TO PART ARE CATALOG PAGES TO CHECK FOR MORE INFORMATION ABOUT THE PART AND OPTIONS.
GASKET SET (3): “I WANT EVERY GASKET” SET ____ “LEAST COMPLETE” SET ____
WITH STOCK HEAD GASKETS ____ WITHOUT HEAD GASKETS ____ (WE WILL ADD COPPER HEAD GASKETS, REQUIRED FOR +.030” BORE OR LARGER)
ENGINE TO BODY SEAL? YES ____ NO ____
CRANKSHAFT (27): CRANKSHAFT KIT YES ____ NO ____
IF YES: NITRIDED? ____ NEW BRONZE DISTRIBUTOR GEAR? ____
IF NO: MAIN BEARINGS: NO ____ YES ____ SIZE: ____
ROD BEARINGS: NO ____ YES ____ SIZE: ____
CAMSHAFT (27-27A): YES ____ (NEW LIFTERS REQUIRED) NO ____
IF YES: STOCK GRIND? ____ PERFORMANCE GRIND? ____ LEVEL OF PERFORMANCE (1-5) ____
NEW CAM? ____ REGROUND CAM? ____ REVERSE ROTATION? ____
STOCK GEAR INSTALLED? ____ FAILSAFE GEAR INSTALLED? ____
CONNECTING RODS (25): YES ____ NO ____
IF YES: REGULAR ____ BALANCED ____ LIGHTENED AND BALANCED ____ $ SAVER ____
IF NO: NEW ROD BOLTS AND NUTS YES ____ NO ____
CYLINDERS (23B): YES ____ NO ____
IF YES: BORE SIZE? _____ BORED GM CYLINDERS? ____ NEW FULL FIN CYLINDERS? ____
PISTONS (22-23): YES ____ NO ____
IF YES: CAST ____ HI-TECH ____ FORGED ____
SERVICES (21): BALANCED? ____ OCTANE CUT (ONLY FORGED) ____ PRESS ON RODS ____
PISTON RINGS (24): YES ____ NO ____
IF YES: CAST IRON ____ CHROME _____ MOLY ____
(IF YOU SELECT CYLINDERS, PISTONS AND PISTON RINGS WE WILL MAKE IT A KIT)
HEAD STUDS (13): NONE ____
UPPER: STD. QTY ____ +.003 QTY ____ +.006 QTY ____ SUPER DUTY ____
LOWER: STD. QTY ____ +.003 QTY ____ +.006 QTY ____ SUPER DUTY ____
HEAD NUTS (13): NO ____ YES ____ CHROME ACORN CAP NUTS ____
ROCKER STUDS (18): NONE ____
RACE QUALITY ____ QTY ____
NOS (Seldom have) ____ QTY ____
STOCK USED ____ QTY ____
VALVES (17,20): YES ____ NO ____
IF YES: INTAKE QTY ____ EXHAUST QTY ____
VALVE GUIDES (20): YES ____ NO ____
IF YES: QTY NEEDED ____ OVERSIZE NEEDED? ____ SUPER SAFE? ____
VALVE SEATS (17): NO____ YES____ QTY____
Size: STD____ +.005”____ +.010”____ +.030”____
VALVE STEM KEYS (18): NONE ____ INTAKE QTY ____ EXHAUST QTY ____
VALVE SPRING CAPS (17): NONE ____ QTY ____
VALVE SPRINGS (17): NONE ____ STOCK ____ HIGH PERFORMANCE ____
ROCKER ARMS (18): NONE ____
STOCK WITH PLAIN BALL ____ QTY ____
STOCK WITH GROOVED BALL ____ QTY ____
SET OF 12 “MATED” WITH GROOVED BALL ____
ROLLER ROCKER SET OF 12 ____
LIFTERS (19): NO ____ YES ____ QTY ____ (NEED NEW LIFTERS WITH NEW CAM)
PUSH RODS (19-20): NONE ____
STOCK ____ QTY ____
HEAVY DUTY ____ QTY ____ OVER/UNDER SIZE NEEDED ____
PUSH ROD GEOMETRY KIT (20): YES ____ NO ____
OIL PUMP (12): NO ____ STOCK ____ PRO HI-VOLUME ____ $ SAVER HI-VOLUME ____
BLOWER FAN BEARING (10): NONE ____ BARE BEARING ____
BEARING WITH STOCK STEEL HUB ____ BEARING WITH ALUMINUM HUB ____
BEARING AND HUB IN USED TOP BLOCK COVER ____ (ALSO SELECT HUB TYPE ABOVE)
TOP BLOCK COVER BOLTS (181): NONE ____ SHAKE-PROOF SET ____
IDLER PULLEY (11): NONE ____ BARE BEARING ____ BRACKET, BEARING AND PULLEY ____
CRANK PULLEY/HARMONIC BALANCER (11): NONE ____ REGULAR ____ DEGREED ____
FAN BELT (14): NONE ____ CLARKS ____ OTTO ____ EXACT REPRO ____ SLOTTED ____
ENGINE SHROUD BOLTS (181): NONE ____ SIZE ____ QTY ____
SIZE ____ QTY ____
SIZE ____ QTY ____
PLASTIGAGE (26): YES ____ NO ____
OIL PAN (29-30): NONE ____ CLARK ALUMINUM ____ OTTO ALUMINUM ____
ECONO ALUMINUM ____ STOCK REPRO____ OTTO POLISHED FINS ____
VALVE COVERS (29-30): NONE ____ CLARK ALUMINUM ____ OTTO ALUMINUM ____
ECONO ALUMINUM ____ STOCK ____ OTTO POLISHED FINS ____
HOW MANY BOLT HOLES PER COVER? FOUR-HOLE ____ SIX-HOLE ____
THERMOSTATS (106): YES ____ NO ____
ADITIONAL PARTS TO CONSIDER (“WHILE YOU’RE IN THERE”):
