Quick Assessment Form

For a quick evaluation of your car for Surbo installation, please fill in the following fields as completely as possible. Thank you!
YOUR NAME
EMAIL
OTHER EMAIL/ TEL NO.
(If we fail to connect to your emails, we will list you on "Can't Contact These Customers" so you can write in via another email.)
COUNTRY
CITY
MAKE
MODEL
MANUAL/ AUTO?
PETROL/ DIESEL?
YEAR MADE
ENGINE CC
CARB/ FUEL-INJECTED/ TURBO?
AIR INTAKE PIPE: ORIGINAL/ MODIFIED?
IF MODIFIED, DESCRIBE PIPE, OR SEND A PICTURE

AIR FILTER BOX: ORIGINAL/ MODIFIED?
IF MODIFIED, OR REMOVED, PLEASE DESCRIBE

AIR FILTER: ORIGINAL/ MODIFIED?
OTHER MODIFICATIONS

Survey


How did you know about Surbo?
If found via a search, what was your search string?
What is your present fuel consumption?
Is there something you want for your car, or any problem you are trying to solve?

The Surbo element (inserted into the original air intake or a supplied black housing) comes in blue, gold, red (fire), maroon (dark red), black (hides well), green and gun metal (brown). What is your preferred colour or colours, or would you like a different shade?

Dealership Application


I WANT TO BE A DEALER IN:
MY TEL NO. AND EMAIL FOR WEBSITE LISTING:
REQUEST FOR DEALER PRICES AND TERMS? YES/NO
MOST COMMON CAR MODELS IN YOUR AREA

Summary of marketing plans and desired sales per period

If your modem was ever turned off during this session (offline), fill in the form, click edit, select all, copy and paste onto an email to surbo@pacific.net.sg.

If you are unable to submit the form at all, please just email us at surbo@pacific.net.sg. Thank you.