Wiring Harness Conversion Packing Slip

Name:________________________________________________

Conversion (What engine are you putting into what car): ______________________________________________________

Phone number(s):_______________________________________

Email address:__________________________________________

Return Address:




Method of Payment (check one)
( Money Order Enclosed
( Money Order mailed separately
( Paypal (Paypal address or username:_____________________)

Amount sent: _______________ ( Paid for Priority Service

How did you hear about us?_______________________________

Notes: