custom request form
TakaMotorsports.Com
P.O. Box 252214
LA, CA 90025-2214

To accurately submit a request for a custom product, please fill out the form to the best of your knowledge and a representative will answer the inquery as soon as possible. Your information is confidential and will not be shared with outside sources. Most responses will be answered via e-mail, though we would appreciate it if you fill out the form completely so that we may alternate ways to reach you. Thank you.
First Name:
 Last Name:

Full Address (Please include Street, City, State, and Zip Code):
Phone Number (Please include Area Code):
Best Time to Reach You: (Days and Times):
Make of Vehicle (Year / Make / Model / ABS or Non ABS):
Application (Front or Rear Brake Lines, Clutch Line, Fuel Line, etc.):

Additional Comments:


TakaMotorsports.com is a registered trademark of Taka, Inc. (c) 2002. All rights reserved. Commercial use or reproduction without expressed written consent of TakaMotorsports.com is strictly prohibited. All registered logos and images are trademarks of their respective owners. Please contact us for further information.