New Customer Form

Standard New Customer Form
Name:*
Email*
example@example.com
Phone Number:*
Address:*
Vehicle:*
Vehicle Use:*
Drag race (Super Pro, Pro, Sportsman, NHRA Super Classes), Dirt Racing, Oval Track Racing, etc.
Data Logging and Sensors:*

Racepak UDXRacepak iQ3Racepak V300Racepak V500Racepak SportsmanOil PressureFuel PressureVacuumDriveshaft RPMBottle PressureN2O Fuel PressureWideband (Racepak)Wideband (Power Grid)Wideband (Other)Oil TemperatureCoolant TemperatureTrans Main Line PressureTrans TemperatureShock TravelTrack TemperatureOther
Do You Plan to Ever Use Data Acquisition?:*

YesNo
Switch Panel/Relay Board*

K&RDigital DelayPainlessAutorod ControlsNorman Racing Services Custom BuildOther
Ignition/ECU*

Power Grid IgnitionPower Grid ControllerMSD Digital 7MSD 7AL-2MSD 7AL-3MSD Digital 6MSD 6ALMSD LSMSD 3 Step ModuleMSD 2 Step ModuleMSD CoilLS Coils8 Injectors16 InjectorsHolley Terminator XHolley Terminator X MAX
Lighting*

Low BeamHigh BeamMarkerTailBrakeReverseTurn Signals/HazardsInteriorEngine BayTrunk/Fuel CellTransmissionRear EndUnder DashOther
Chassis Interior*

Race RadioRadioShifter (Neutral Safety/Reverse Lights, etc)Electric Shift SolenoidCO2 Shift SolenoidNitrous Bottle HeaterMaster Kill Switch (Inside Car)Power WindowsOther
Engine Bay*

Nitrous Plate SystemNitrous Fogger SystemSingle Stage Nitrous2 Stage NitrousAlternatorLine LockFront Mount Fuel PumpWater PumpEngine Cooling FanTrans Cooling FanOther
Chassis (Other)*

Charging PortsRear Mount Fuel PumpMaster Kill Switch (Rear of Car)Other
Gauges*

Display DashRPMVoltageFuel PressureOil PressureWater TemperatureTrans temperatureOil TemperatureVacuumBrake PressureOther
Buttons and Switches*

Transbrake (Snap Action)Transbrake (Long Throw)Line LockBump UpBump DownN2O OverrideStarter Bump (Passenger Side)Starter Bump (Driver Side)Starter Bump (Converter)Back Up SwitchOther
Other Electronics*

Delay BoxShift ControllerThrottle StopThrottle EnhancerQuick Change Box to No BoxDigital Dial BoardsDigital Dial Board ControllersOther
Delay Box Brand (If Applicable)
Do you Want/Need New Battery Cables?*

YesNoDetermine For Me
Do you have any brackets, panels, etc. that will need made?*
Color Schemes for Brackets (i.e. Black, Carbon Fiber, Blue, etc.)*
Do You Want Labeled Shrink Tubing?

YesNo
Is There Anything Else We Need to Know?*
Do not turn onto Beech Street if your GPS tells you to. Continue on Route 62 until you get to the Alliance Exit*
Type "Yes" to Acknowledge
Call before you get to this point. You'll drive past my place to the next driveway, then back into my driveway. Watch out for Mailboxes and try not to go into the front yard. You car will be started or pushed to the back shop from the front driveway.*
Type "Yes" to Acknowledge
For further questions please call Ryan at 740-260-7023

Designed by Ryan Norman
Should be Empty:

Standard New Customer Form