Please type in the following information and Print Out this form
or, alternatively
Clearly hand-write the following information.

Include it with your part and ship to:
The Rebuilding Factory
1390 Flynn Road, Unit C
Camarillo, CA  93012

The Rebuilding Factory
Click Here To Go To The Rebuilding Factory Home Page
Contact Information
Name:
Address:
Phone:
 
(Example: 805-555-1212)
E-mail:
 
(Example: MikeT@hotmail.com)
Part Type:
 
(Example: starter, alternator, generator, FWD Axle, etc.)
   
Application Information (Car, Truck, Boat, Etc.)
Make:
 
(Example: Ford)
Model:
 
(Example: Fairlane)
Year:
 
(Example: 1967)
Engine Cyl:
 
(Example: 4 Cylinder  or  8 Cylinder)
Engine Size:
 
(Example: 3.2 Liter  or  350 CID)
Transmission: Automatic      Manual      Not Applicable
Other Details and Special Requests
Other:
(Please include as much additional information as possible)