Pre-Ignition Catalytic Converter (PICC) Advance Order

 

I would like to advance order a customized Pre-Ignition Catalytic Converter (PICC) for my vehicle(s).

I understand that this advance order does not commit me to purchasing the PICC, but puts me in line to notify Gasally.Com that I would like a quote on the cost for a PICC for my vehicle as soon as that is possible.

I also understand the PICC is custom made and that the supplier plans to have the most requested models manufactured first. The timing of this quote will be based upon the make and model of my vehicle and could take some time. I do not need to send any money in with this request in advance of receiving a quote back. I will merely fill out and submit the PICC quote request form below. When I recieve the quote back it will state the exact price, delivery time, and the projected fuel saving for my vehicle(s).

You may submit vehicle information for up to 3 vehicles on this form.

Be certain to indicate on the bottom of this form (last box) as to your preference to order the preferred customer HAFC service while you are waiting for the PICC to be built for your vehicle. Start saving today! The HAFC is the first step of a two step modification, and taking the second step is OPTIONAL. You may just continue on wtih the benefits realized with your HAFC Guarantee. GUARANTEE - receive a 50% increase in fuel economy or return your kit for a 100% refund within 30 days. (less mechanics fees)

Required fields in bold - VIN Numbers - Please provide only the first 8 Numbers/Letters listed in the vehicle identification number (VIN). Your VIN information is ususally located by looking through your front windshield in the lower left hand corner at the botom of your interior dashboard. There is absolutely no security risk providing this information. This data will help us determine your vehicles custom PICC configuration requirements.

Sales Rep Name (if any):

First / Last Name:

Home Phone:

(999-999-9999)

Work Phone:

(999-999-9999x123)

Other Phone:

(cell / FAX 999-999-9999)

Email address:

(name@domainname.com)

Mailing Address

 

Address Line 1:

Address Line 2

City:

State/Province:

  Zip/Postal Code: (US 12345 or 12345-1234, Canada A1B 2C3)

Country:

Vehicle 1 Information:

VIN #:

Year:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Manufacture:

Model:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

# of Cylinders:   # of Catalytic Converters: Dual or Single Exhaust:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fuel System Type:  Fuel Now Used:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Mileage in Town: Current Highway Mileage:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle 2 Information:

VIN #:

Year:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Manufacture:

Model:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

# of Cylinders:   # of Catalytic Converters: Dual or Single Exhaust: