Engine Order Form

                                                                         Date ________________

Company Name _____________________________________

Address ____________________________________________

   ____________________________________________

Phone # ____________________ Fax # __________________

Contact person ______________________________________

P.O. # _____________________________

Tractor Size ________________ Tractor Series ___________________

Tractor Serial # ____________________ Engine Size __________________

Engine Serial # (Required on all 504) _____________________________

Select One:

                      _____ Complete Engine

                                         _____ Manual Kill

                                         _____ Electric Kill

                      _____ Short Block

                      _____ Short Block with Head

Select One:    _____ Turbo

                      _____ Non-Turbo

25% Restocking Fee + All Freight Charges on any miss ordered or cancelled engine sale. 

Shipping:       _____ Yellow

                      _____ Roadway

                      _____ R & L

                      _____ Overnite

                      _____ Other ( Please Specify) ____________________________

All engines will be shipped to you freight collect.  We pay the freight charges on your returned core.  (On an approved freight company)

Customer’s Signature __________________________________________

Return to: Hagan Tractor Parts, Inc.

                 Broken Arrow, OK 74014

                 800-365-0602

                 918-251-1851 Fax