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If you're a member of the print or electronic news media working on a project car, we'd like you to consider using Edelbrock parts. Please fill out the form below, and we'll give your request immediate consideration.

This form is strictly for Media/Project requests such as a magazine article or a TV show and should not be used for other types of requests, i.e. decals, etc.

Note: You can also download a printable form for sending your requests by way of fax. Fax your completed form to (310) 320-3964.

Parts Request Form (pdf) | Parts Request Form (.xls)


Media/Project Request Form

Date Items Needed By:
 
Contact Info:
Publication:
Requested By:
Title:
Writer's Name:
 
Address1:
Address2:
City:
State:
Zip:
Country:
Phone:
Cell:
Fax:
E-mail (required):
 
Items Requested:

1. Qty: Part #: Description:
2. Qty: Part #: Description:
3. Qty: Part #: Description:
4. Qty: Part #: Description:
5. Qty: Part #: Description:
6. Qty: Part #: Description:
7. Qty: Part #: Description:
8. Qty: Part #: Description:
9. Qty: Part #: Description:
10. Qty: Part #: Description:
 
Reason/Purpose:
Magazine Publication Date/Product Exposure Plan:
Special Instructions:
 
 
By submitting this form, I certify that this project vehicle is intended for use in an article in a publication of general circulation, that it is not for private or personal use, and that Edebrock will receive appropriate mention as a supplier for this project.

To help us with our accounting and record keeping, we would appreciate a copy of your article as soon as it written. Kindly send it to:

Edelbrock, LLC
Attn: Marilou Cimafranca
2700 California St.
Torrance, CA 90503.

Thank You