Order Form: Mail to Electro Automotive, POB 1113-W, Felton, CA 95018
Quan. Item Price Ea. Item Tot. Ship. Tot.
Column Totals     
9% Sales Tax on Merchandise Total (CA Only)    XXXXXX
Total Enclosed  
Battery Pack Info
Pack Volts Brand Model Flooded, Gel, or AGM? Amp Hours
For Adaptor or Kit Orders, Include Donor Car Info & Send Paper Transmission Outline Tracing, Rubbing of Flywheel Hole Pattern, & Flyhweel Photo to Confirm Pattern Match
Make Model Mo. & Yr. Vehicle ID # Eng. Size
Bill To: Ship To:
Name   Name  
Address   Address  
City/State   City/State  
Zip Code   Zip Code  
H Phone   W Phone  
C Phone   Email