Please print and complete this form and fax to Truck Parts Specialists at 1-303-320-7724.

CUSTOMER NAME:____________________________ REF UNIT#:______________

ADDRESS:____________________________________________________________

CITY:_____________________ STATE:_____ ZIP:_______________________

CONTACT:___________________________________ PHONE:_________________

QUANTITY OF IDENTICAL VEHICLES FOR THIS ORDER:______________________

DESCRIPTION OF VEHICLE: (fire truck, school bus, etc.) ______________

VEHICLE MAKE:______________ MODEL:_______________ YEAR:_____________

Note: The following information applies to REAR SUSPENSION ONLY!

AXLE MAKE:_______________ CAPACITY:_____________ TANDEM/SINGLE

AXLE SPEED: SINGLE/TWO

TIRE SIZE:____________ BRAND:_____________

AIR BRAKES: YES/NO
AIR BRAKE CHAMBER LOCATION: FRONT/BACK/BOTH

DISC BRAKES: YES/NO
SUSPENSION TYPE: SPRING/AIR/OTHER_________

SHOCK ON REAR AXLE: YES/NO
SHOCK LOCATION: FRONT/BACK

SHOCK BRACKET: YES/NO
IF YES, SHOCK BRACKET THICKNESS:_________________________

TORSION BAR/SWAY BAR: YES/NO
SWAY BAR LOCATION: FRONT/BACK

ARE THERE ANY OBSTRUCTIONS 36 INCHES IN FRONT OF OR BEHIND THE REAR AXLE THAT WOULD PREVENT THE ONSPOT INSTALLATION (i.e. fuel tank, air tank, exhaust, driveline retarders, cabinets etc.)

IF SO, INDICATE ITEM AND DISTANCE FROM AXLE, FROM GROUND AND FROM TIRE:

______________________________________________________________________

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Depth of round A=_____________
(A) The distance from the lowest part of the saddle plate to where the u-bolt nut contacts the saddle plate. (NOTE: this dimension does NOT apply to all axles)

Height in front BF=_______________
(BF) The distance from the ground to where the front u-bolt nuts contact the saddle plate.

Height in back BB=_____________
(BB) The distance from the ground to where the rear u-bolt nuts contact the saddle plate.

NOTE: If the BF or BB measurements are to the bottom of a shock bracket that is held in place by the u-bolt nuts, PLEASE INDICATE.

Sidewall distance C=______________
(C) The distance from the tire bulge (approximately 3 1/2 - 4 inches off the ground) to the center of the u-bolt closest to the tire. This measurement is best taken by hanging a plumb bob from the CENTER of the u-bolt and measuring to the tire bulge.

Remaining u-bolt D=________________
(D) The thread remaining below the u-bolt nuts (in inches)

Nut height thickness E=_______________
(E) The thickness of the u-bolt nut (and washer if applicable)

U-bolt diameter X=______________fine/coarse
(X) The diameter of the u-bolt. Fine or Coarse thread. CAUTION: Some u-bolts may be metric!

Front to rear Y=______________
(Y) The CENTER to CENTER distance of the u-bolts, front to back.

Side to side Z=______________
(Z) The CENTER to CENTER distance of the u-bolts, side to side.

Brake chamber to ground GB=_________________
(GB) The distance from the ground to the LOWEST POINT of the air brake chamber.

Brake chamber to tire. SB=__________________
(SB) The distance from the tire sidewall to the CENTER of the air brake chamber.

Brake chamber to front u-bolt. UB=_________________
(UB) The distance from the FRONT U BOLT to the air brake chamber.

NOTE: GB, SB and UB measurements are to the SAME REFERENCE POINT on the air brake chamber.