Subject: *
E-mail Address: *
Name *
Preferred Method of Contact	Phone Email
Phone Number
Shipping Zip Code
Year of Vehicle Manufacture
Make
Model
Location of Needed Supports
Qty. on Vehicle
Size: Length, Fully Extended (A) See Image Below)
Size: Length Retracted Fully (B) See Image Below
Pressure Listed on old Unit Ending with the Letter N (300N, ect.)/ Or Desired Pressure

Type of End, Shaft Side	Ball Socket Eyelet
Type of End, Body Side	Ball Socket Eyelet
*********VERY IMPORTANT********* Please indicate ALL** numbers or markings on the original support.
Attach an Image to assist with your request for assistance.
If bracket is attached please describe, or attach photo.
Additional Comments


* Required