CUSTOM CHIP or PCM  ORDER :
(TO RETAIN THE STOCK PARAMETERS WRITE IN THE WORD "STOCK")

Customer's Name: ___________________________________________________________

Billing Address: ___________________________________________________________

Shipping Address:___________________________________________________________

City: _______________________________________State:_______ ZIP:_____________

DATE: ___________Day Time Phone:____________________________________________

CREDIT CARD # ______________________________________________________________

3 Digit Code on Back of Card:_____Visa Master Card Discover American Express

EXPIRATION DATE____________We Ship Federal Express:  NEXT DAY? 2 DAY? 3 DAY? 
				           
					   (Applies to Removable Chips Only:)
VIN:________________________________________ 4 Letter PROM Code _____________

Vehicle year/make/model: ____________________________________________________

Engine Selection, please circle one.

LS2?  LS1/LS6?  LT1/LT4?  TBI? TPI? 3800V6?  Blown? Turbo? NOS? Vortec Truck?  

Engine size_____Injector Size/Brand?______________Desired Idle?______________

Throttle Body size________________Intake Manifold____________________________

Camshaft duration @.050"___________________Lift?______Cam LSA ?______________

Aftermarket Roller Rockers?_________________If so, What Ratio?_______________

Cylinder Heads?____________________________Are They Ported?__________________

Blower/Turbo Brand?________________Boost______Inter-Cooled?_______FMU?_______

Compression ratio______________EGR?__________Thermostat Temp_________________

Exhaust System__________________________________________________Cats?________

Transmission:_____________________________ Shift Kit Installed? _____________

Torque Converter___________Rear gear ratio_________Firm the Shifts?__________

Stock Tire Size _______________________ New Tire Size________________________

WOT Shift RPM:___________________________ Rev limiters:______________________

What MAF Sensor?________________________ Trouble codes? _____________________

Where did you hear about us?_________________________________________________ 

Please circle one --->   Customer's PCM?            We furnish exchange PCM?
Ed Wright Automotive Inc,    1114 West 41st Street,          Tulsa, OK 74107

Ph: 918-446-3019 			     		   Fax: 918-446-1233