Date: ____________________________ Date Requested: ____________________

Phone Number: (where you can be reached): ________________________________

Name:_____________________________________________________

Phone:_____________________________________________________

Address:___________________________________________________

Model:____________________________________________________

Year:_____________________________________

Please mark the WRI engine build type you prefer.
Cost is determined on specific parts installed.

• WRI high compression piston

• WRI cam(s)

• WRI valve and spring kit

What types of riding/racing do you compete in?______________________

How often do you practice, race, or ride? Annually, Daily, Weekly, Monthly?___________________________________________________

Part(s) needed to complete modification:

• complete engine

• carburetor, if needed to modify

When complete, please mail part(s) and form to: