Electrimotion Order Form
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Company Name *
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Company Phone Number
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Contact Name
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Contact Email Address
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Shipping Address
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Shipping City, State, Zip
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Billing Address
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Billing City, State, Zip
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Safety Box
TF,FC,TAFC,TAD,
A-Fuel , PM $425.
Nos FC & TF $375
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Top Fuel
Dragster
Top Fuel Funny
Car
Top Alcohol
Dragster
A-Fuel
Dragster
Alcohol Funny
car
Nostalgia TF
Nostalgia FC
Pro-Mod (Specify Blown Alky or other in Notes)
Includes Safety Box, Air valve, Tether cord, Manifold Tether and hardware.
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Replacement Tether Kits $65 ea
Enter Qty in Note Field
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TopFuel
Alky
Nostalgia TF
Nostalgia FC
Pro-Mod
Includes 1 Tether, 6" for Topfuel or 32" for Alcohol and Pro-Mod, 1 Manifold Anchor, and Tether Dog Bones
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Air Cylinders $33 ea
Enter Qty required
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*Not Included in the Safety Box Kit.
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RF Shutdown Kit
Topfuel $250
Alky/ProMod $250
Pro-Stock $375
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TopFuel
Alky
Pro-Mod
ProStock/Comp
NHRA/ADRL
TF/Alky/ProMod require Safety Box SB001
Pro-Stock/Comp does not require the Safety Box SB001
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Crank Triggers $140
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90 Deg, 18", Amp Connector (Standard for Blown Alcohol)
Other, Please specify in note field below
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Other Notes
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Please tell us what sanctioning body and type car you are running in this box.
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