Request Edelbrock Parts Here

If you're a member of the print or electronic news media working on a project car, we'd like you to consider using Edelbrock parts. Please fill out the form below, and we'll give your request immediate consideration.
This form is strictly for Media/Project requests such as a magazine article or a TV show and should not be used for other types of requests, i.e. decals, etc.
Note: You can also download a printable form for sending your requests by way of fax. Fax your completed form to (310) 320-3964.
Parts Request Form (pdf) | Parts Request Form (.xls)

Media/Project Request Form

Date Items
Needed By:

Contact Info:

Publication:

Requested By:

Title:

Writer's Name:

Address1:

Address2:

City:

State:

Zip:

Country:

Phone:

Cell:

Fax:

E-mail (required):

Items Requested:

1. Qty:

Part #: Description:

2. Qty:

Part #: Description:

3. Qty:

Part #: Description:

4. Qty:

Part #: Description:

5. Qty:

Part #: Description:

6. Qty:

Part #: Description:

7. Qty:

Part #: Description:

8. Qty:

Part #: Description:

9. Qty:

Part #: Description:

10. Qty:

Part #: Description:

Reason/Purpose:

Magazine Publication Date/Product Exposure Plan:

Special Instructions:

By submitting this form, I certify that this project vehicle is intended for use in an article in a publication of general circulation, that it is not for private or personal use, and that Edebrock will receive appropriate mention as a supplier for this project.

To help us with our accounting and record keeping, we would appreciate a copy of your article as soon as it written. Kindly send it to: Edelbrock Corporation, Attn: Marilou Cimafranca, 2700 California St., Torrance, CA 90503. Thank You.