Core Submission Form
🛠️ Moose Diesel Core Return Submission Form
Shipping Address:
Moose Diesel – Core Returns 3830 B Augusta Hwy Gilbert, SC 29054
👉 Important: Clearly write CORE RETURN on the outside of the box.
✍️ Instructions
You may print and fill out this form, or use your own paper and include all requested information. Please PRINT NEATLY to avoid delays.
🔢 Order Details
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Invoice Number: _______________________________________
👤 Customer Information
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First Name: ____________________________________________
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Last Name: _____________________________________________
📦 Shipping Address (if different from billing)
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Street: ________________________________________________
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City: _________________________________________________
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State: ________________________________________________
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ZIP Code: _____________________________________________
📬 Mailing Address (if different from shipping)
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Street: ________________________________________________
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City: _________________________________________________
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State: ________________________________________________
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ZIP Code: _____________________________________________
📞 Contact Information
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Phone Number: (_______) _______________________________
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Email Address: _________________________________________
🚗 Vehicle Information (circle all that apply)
Ford
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6.9L 7.3L Model Year: __________
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Turbocharged? ⭕ Yes ⭕ No
Chevy
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6.2L 6.5L HMVW
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Voltage: ⭕ 12V ⭕ 24V
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Transmission Type: ________________________
Other
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Make: ____________________ Model: ____________________
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Model Year: _________________
🔧 If Ordering Ford Moose Buddy Injectors: Return Line Kit Selection (circle one)
⭕ 6.9L Standard ⭕ 6.9L Advanced ⭕ 7.3L Standard ⭕ 7.3L Advanced