| E-mail Address: * |
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| Your Name * |
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| Street Address 1 * |
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| Street Address 2 |
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| City * |
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| State, Province or U.S. Territory * |
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| Zip Code * |
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| Comments |
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| Trim Tag Date (e.g. 01A) |
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| Final Assembly Plant
* |
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| Body Number * |
(number after plant designator on trim tag,
not on buildsheet) |
| Interior Trim Code * |
(such as 756) |
| Exterior Paint Code(s)
* |
(lower and upper codes such as 19 19, 19 B, etc.) |
| Transmission Type * |
M22
4-Speed
M40
TH400 |
| Rear End Gear (original, not current) |
(such as 3.31:1 or 4.10:1) |
| Positraction |
Yes
No
Don't
Know |
| Cowl Induction? * |
Yes
No |
| VIN (complete)
* |
(such as 136370A123456) |
| Dealer Name from buildsheet |
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| Sched NO-Date From Block 10 of buildsheet (e.g.,
02 01-05) |
(such as 02 01-05, 01-0257, etc. depending on
assembly plant) |
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| Verification Code: |
 |
| Enter Verification Code above:
* |
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* Required |
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