Leased Owner Information

Name

First Name

Last Name

Phone

(###)

###

####

Year, Make, Model of Your Truck

Engine

Transmission

Rear Gear Ratio

Is the truck paid for?

Date/Mileage of Last Engine Rebuild

Date/Mileage of Last Transmission Rebuild

Date/Mileage of Last Overhead Valve Adjustment

Date/Mileage of Rear Gear Rebuild/Replacement

Has the Truck Been Modified for Fuel Mileage?

OPS Oil Purification System