Turbo Action Order Blank
Date______________ Purchase Order _____________ Per  ______________PickTicket_____________ 

Account #___________________ Name _________________________________________________ 
Company Name_____________________________________________________________________  
Address __________________________________________________________________________  
City ________________State ____ ZIP________Country_________County (FL Only)_____________ 
Work Phone____________________(Home) ____________(Dedicated FAX Line)_________________  
 

General Information 
Type Trans. _________ PG & C4 Spline_________ 
        Length of Tail Housing_______4X4 ________ 
        C4 Case Filled______Pan Filled____________ 
             Bell Housing________________________  
Make Engine__________Cu.ln._______________ 
      Type Heads ___________________________ 
Mid Engine Plate (Thickness)_________________ 
Vehicle:Year _________Make________________ 
        Chassis Car____Dragster________________ 
        Rear End Ratio______Weight  ____________  
Tire Brand(Rear)________Street ____ Slick _____  
        Width _______Dia.______Roll Out________ 
Street Driven _______% of time______________ 
Class or Classes 
         IHRA_______________________________ 
        NHRA_______________________________		 Transmission Orders 
What Brand of Shifter ________Model ________  
Ford Shifter, Column or Console______________ 
Mopar 1962-65 Pushbutton or Console__________ 

Converter Orders 
Nitrous____________Horsepower___________  
Blower ____________ Size_________________ 
Tranz Brake_____________________________ 
Cam Brand______________________________ 
Type CAM: Hydraulic____Solid____Roller_____ 
Duration: At 0.050"    IN________EX_________ 
                  Adv.           IN________EX_________ 
                  Lift              IN________EX_________ 
Centerline_________Shift Points_____________ 
Manifold__________Carbs_________________ 
Headers: Collector Dia.______Primary Tube_____ 
 
Qty      Part#           Description                  Unit Cost         Qty     Part#               Description                   Unit Cost 
___     _______   ________________    ________      ____   ________     ________________   _______ 
___     _______   ________________    ________      ____   ________     ________________   _______ 
___     _______   ________________    ________      ____   ________     ________________   _______ 
___     _______   ________________    ________      ____   ________     ________________   _______ 
___     _______   ________________    ________      ____   ________     ________________   _______ 
___     _______   ________________    ________      ____   ________     ________________   _______ 
___     _______   ________________    ________      ____   ________     ________________   _______ 
Notes_____________________________________________________________________________ 

Shipping Information       (New account requires deposit on transmission orders)
Ship VIA UPS________ COD_______Truck _________ Other _________Promised Date ____________  
Special Instructions__________________________________________________________________  
Credit Card.- (Circle One) V - MC - DC # ____________________________Exp.___________________ 
Name On Card ________________________________________________
Billing Address _____________________________________________________________________  
City ________________State ____ ZIP________Country_________County (FL Only)_____________ 

Turbo Action  FAX #  904-741-4853