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
-
Invoice Number: _______________________________________
👤 Customer Information
-
First Name: ____________________________________________
-
Last Name: _____________________________________________
📦 Shipping Address (if different from billing)
-
Street: ________________________________________________
-
City: _________________________________________________
-
State: ________________________________________________
-
ZIP Code: _____________________________________________
📬 Mailing Address (if different from shipping)
-
Street: ________________________________________________
-
City: _________________________________________________
-
State: ________________________________________________
-
ZIP Code: _____________________________________________
📞 Contact Information
-
Phone Number: (_______) _______________________________
-
Email Address: _________________________________________
🚗 Vehicle Information (circle all that apply)
Ford
-
6.9L 7.3L Model Year: __________
-
Turbocharged? ⭕ Yes ⭕ No
Chevy
-
6.2L 6.5L HMVW
-
Voltage: ⭕ 12V ⭕ 24V
-
Transmission Type: ________________________
Other
-
Make: ____________________ Model: ____________________
-
Model Year: _________________
🔧 Ford Return Line Kit Selection (circle one)
⭕ 6.9L Standard ⭕ 6.9L Advanced ⭕ 7.3L Standard ⭕ 7.3L Advanced