PERSONAL INFORMATION

First Name:        Last Name: 
Address line 1:
Address line 2:
City:       State:       Zip:
Phone #:        E-Mail:  

VEHICLE INFORMATION

Car Model: BUICK, GSX       Year produced: 1972
Vehicle Identification #: (essential)
Color:       Engine Type: 350 455 455 Stage-1
Transmission Type: TH350 Automatic TH400 Automatic Muncie M-20 Manual Muncie M-21 Manual Muncie M-22 Manual       Gear Ratio:
Body Plate # (essential information)
ST BDY
TR PNT

EXAMPLE
ST 70 44637FL1 123456 BDY
TR 188 Q-Q PNT
04D

Dealership Number: (12-345)
Dealership:
Address:
   
City: State: Zip:
Previous Owners:

History of the Car:

History of the Owner:

PLEASE PLACE A CHECK IN THIS IF YOU DO NOT WANT THIS INFORMATION PRINTED.  PLEASE PLACE A CHECK ON THE LINE THAT INDICATE THE OPTIONS ON YOUR CAR.

OPTIONS DESCRIPTION OF OPTIONS

A1  = STAGE-1 PERFORMANCE OPTION (INCLUDING HIGH PERFORMANCE 455 CU. IN. MODIFIED
                ENGINE AND SPECIFIC RELATED PARTS (B2 OR B3 AND C1 REQUIRED)
A9  = STANDARD 455 MOTOR

B2  = TURBO HYDRA-MATIC 400 TRANSMISSION (A1 OR A9 ANC C1 REQUIRED)
B3  = 4 SPEED MANUAL FLOOR SHIFT TRANSMISSION (N.A WITH B4)
B4  = FULL LENGTH CONSOLE (AUTO TRANS AND BUCKET SEATS REQUIRED)
B5  = TURBO HYDRA-MATIC 350 (NA WITH A1 OR A9)
B6  = 3 SPEED MANUAL TRANSMISSION (STD)
B7  = CONSOLETTE (4 SPEED MANUAL FLOOR SHIFT TRANSMISSION AND BUCKET SEATS REQUIRED)
B8  = SHORT NON SHIFT FLOOR CONSOLE (BUCKET SEATS REQUIRED)
BB = B3 + B7    BC = B2 + B4     BE = B4 + B5     BF = B2 + B8   
BG = B3 + B8    BH = B5 + B8    BM = B3 + B7 + B8    BP = B6 + B8

C1  = POWER DISC BRAKES
C4  = MINI CONSOLE ( NA WITH B3, B4 OR D0)
C5  = POWER STEERING - FAST VARIABLE RATIO POWER STEERING 14.6 TO 1 (A1 OR A9 REQUIRED)
C6  = POWER STEERING 17.6 TO 1
C7  = POWER BRAKES
CC  = C6 + C7    CE  = C1 + C6    CF  = C1 + C5     CG  = C1 + C4    CI  = C4 + C5
CJ  = C4 + C6    CK  = C4 + C7    CL  = C4 + C6 + C7    CM  = C1 + C4 + C6    CN  = C1 + C4 + C5

D1  = SONOMATIC RADIO (AM)
D4  = AM-FM STEREO RADIO AND REAR SEAT SPEAKER
D5  = AM-FM RADIO
D6  = REAR SPEAKER
D0  = STEREO TAPE PLAYER (8-TRACK, RADIO AND REAR SPEAKER REQUIRED)
DC  = D1 + D6    DG  = D5 + D6    DN  = D1 + D6 + D0    DT  = D5 + D6 + D0     DU  = D4 + D0

E5  = EXHAUST EMISSIONS SYSTEM (REQ IN CALIFORNIA)
E6  = THROUGH BUMPER EXHAUST EXTENSIONS (N25)
EE  = E5 + E6

F1  = WHITEWALL TIRES
F2  = OVERSIZE WHITEWALL TIRES H78-14
F7  = SUPER WIDE OVAL GROUP (SUPER WIDE OVAL/WHITE BILLBOARD LETTERED
               TIRES G60-15 WITH CHROME PLATED WHEELS)
F9  = WIDE OVAL WHITE BILLBOARD LETTERED TIRES G70-14

G1  = PERFORMANCE AXLE WITH POSITIVE TRACTION (B2 OR B5 REQUIRED)(STD WITH A1)
G2  = PERFORMANCE AXLE WITH NON-POSITIVE TRACTION (B2 OR B5 REQUIRED)(NA WITH A1)
G4  = POSITIVE TRACTION DIFFERENTIAL (NA WITH A1)

H1  = TRAILER HAULING OPTION (HEAVY DUTY SUSPENSION SPRINGS AND WHEELS)
H5  = HEAVY DUTY ENERGIZER (NA WITH A1 OR A9)
H6  = RALLYE FIRM RIDE AND HANDLING (HEAVY DUTY SUSPENSION, SPRINGS AND WHEELS)
H7  = SUPERLIFT SHOCKS (NA WITH H1-H6)
HA  = H1 + H5    HE  = H5 + H6    HM  = H5 + H7

I2  = FORCED COMFORT-FLO VENTILATION (FAN IN DUCTWORK)
I3  = HEAVY DUTY COOLING (HEAVY DUTY RADIATOR, FAN DRIVE THERMO CONTROL,
               FUEL RETURN LINES ON 350 CU IN ENGINE AND 55 AMP DELCOTRON)
I6  = AIR CONDITIONING
IG  = I3 + I6     IK  = I2 + I3

J3 = CUSTOM FRONT AND REAR SEAT BELTS AND CUSTOM
               FRONT SHOULDER BELTS

K3  = SPEED ALERT

L1  = SOFT-RAY TINTED GLASS (ALL GLASS)
L2  = SOFT-RAY TINTED GLASS WINDSHIELD ONLY

M7  = REAR WINDOW DEFROSTER
M8  = ENGINE BLOCK HEATER
MA = M7 + M8

N3  = HEAVY DUTY AIR CLEANER
N5  = FRONT AND REAR BUMPER GUARDS (N6 REQUIRED)
N6  = BUMPER STRIPS FRONT & REAR
NC  = N3 + N6     NE  = N3 + N5     NF  = N5 + N6     NJ  = N3 + N5 + N6

O4  = DOOR GUARDS
O5  = REMOTE CONTROL OUTSIDE REAR VIEW MIRROR
O6  = OUTSIDE REAR VIEW SPORT MIRRORS (LEFT REMOTE AND RIGHT MANUAL)
OA  = O4 + O5     OC  = O4 + O6

P1  = CARPET SAVER AND HANDY MATS
P2  = FRONT CARPET SAVER ONLY

Q5  = POWER SEAT 4-WAY TILT ADJUST
Q9  = CUSTOM PADDED CUSHIONS (FRONT)(STD WITH BUCKET SEATS)
QA  = Q5 + Q9

R1  = POWER WINDOWS
R2  = EXTRA STRENGTH ANTI-FREEZE
RX  = R1 + R2

S6  = CRUISE MASTER (AUTO TRANS REQUIRED)
S7  = TILT STEERING WHEEL (NA WITH B6 OR STANDARD STEERING)
SA  = S6 + S7

T2  = ELECTRIC DOOR LOCKS

U1  = CONVENIENCE GROUP (TRUNK LIGHT, GLOVE BOX LIGHT, ASH TRAY LIGHT, MIRROR MAP LIGHT AND COURTESY LIGHT)
U6  = ELECTRIC CLOCK
U7  = INSTRUMENT GROUP (INSTRUMENT GAUGES AND TACHOMETER)
U9  = INSTRUMENT GAUGES AND RALLYE CLOCK
UA  = U1 + U6    UB = U1 + U7    UD  = U1 + U9

V1  = DELUXE WHEEL COVERS
V2  = CHROME PLATED WHEELS (STD WITH F7)
V3  = WIRE WHEELS COVERS
V4  = SUPER DELUXE WHEEL COVERS ( NA WITH F7)
V7  = SUPER SPORT WHEEL

W2  = CUSTOM UPPER PEAK AND REAR BODY MOLDINGS (BODY SIDE UPPER
                 PEAK, REAR DECK LID & QUARTER EXT.)
W4  = PROTECTIVE BODY SIDE MOLDINGS (BODY SIDE AND FRONT FENDER)
WA  = W2 + W4

X1  = DELUXE STEERING WHEEL
X2  = RALLYE STEERING WHEEL

  DOES THE CAR STILL HAVE THE ORIGINAL DRIVE TRAIN?
  HAS THE CAR BEEN RESTORED?

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COMMENTS