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Individual customerCompany

Customer name / Company name

*

Address

*

Postal code

*

City

*

Country

*

Phone Number

*

E-mail

*

Brand?

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Model and/or version?

*

Year?

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Transmission

—Please choose an option—manualautomatic

Gear lever position?

—Please choose an option—floor/floor tunnelon steering column

Position steering wheel?

*


—Please choose an option—Left-hand drive-LHDRight-hand drive-RHD

Steering wheel lock?

*


—Please choose an option—YesNo

Control switch wires through steering shaft?

—Please choose an option—YesNo

Voltage battery?

—Please choose an option—6V12V24V

Polarity?

—Please choose an option—Positive earthNegative earth

Air conditioning?

—Please choose an option—YesNo

Steering column in a colour other than standard black?

*


—Please choose an option—YesNo
if YES, send colour sample to EZ and there will be a 75€ surcharge.

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Additional information:

Client knows EZP from:

EventInternetSocial mediaMagazineOldtimer-specialistOther
(multiple choices possible)