Insta-Chain VSI Form

Vehicle Suspension Information Form

Before filling out this form, please have vehicle measurements ready.

Print the VSI ORDER FORM in Adobe Acrobat format You may fill out the Adobe version and email or fax it if you wish.
Please print a copy of the measurement page for reference before filling out this form.
Print the E-MAIL versioin of this Measurements Page

Company:

Your Name:

Distributor Name:

Address:

City:

State:

Country:

Zip:

Email:

Phone:

Fax:

Please describe anything unusual about your suspension:

Measurements from Rear Axle Only

Number of vehicles with these measurements:

Vehicle #'s:

Chassis Make:

Model:

Year:

Suspension Make:

Torsion Bar
Above/Below Axle: Above
Below

Suspension Description: Leaf Spring
Air Ride
Walking Beam
Other
If other, please describe:

Axle Make:

Capacity:

Offset Pumpkin: Yes No

Axle: TandemSingle

Axle Speed: Two Single

Tire Size:

Measurements from front/rear of axle: Front
Rear

Air Brake Cylinder: Front of Axle Back of Axle None

Shocks: Front Back None

Shock Bracket
mounted below U-Bolt plate: Yes No N/A

Refer to the measurement diagram for the following values: Measurements Page

Depth of Round: Left

Right

Height of Front: Left

Right

Height of Back: Left

Right

Sidewall Distance: Left

Right

Remaining Thread: Left

Right

Thickness of Shock Bracket:

Bolt Diameter:

Front to Rear:

Side to Side

Thickness of Nut

Coarse or Fine Thread Coarse
Fine

Sidewall of tire to center of brake can:

Distance from lowest part of air can assembly to ground:

Distance from front U-Bolts to front of air canister

Fuel Tank in relation to canister:

If BEHIND axle: Distance from center of axle to fuel tank:

If n/a, are there compartments or obstructions behind axle?
Yes No

Automatic slack adjuster with disc brakes:
Yes No

If yes, Disc or S-Cam:
Disc S-Cam

Comments or Questions:

Copyright © 2001 INSTA-Chain, Inc. All Rights Reserved

Company:
Your Name:
Distributor Name:
Address:
City:
State:
Country:
Zip:
Email:
Phone:
Fax:
Please describe anything unusual about your suspension:
Measurements from Rear Axle Only
Number of vehicles with these measurements:
Vehicle #'s:
Chassis Make:
Model:
Year:
Suspension Make:
Torsion Bar Above/Below Axle:	Above Below
Suspension Description:	Leaf Spring Air Ride Walking Beam Other If other, please describe:
Axle Make:
Capacity:
Offset Pumpkin:	Yes No
Axle:	TandemSingle
Axle Speed:	Two Single
Tire Size:
Measurements from front/rear of axle:	Front Rear
Air Brake Cylinder:	Front of Axle Back of Axle None
Shocks:	Front Back None
Shock Bracket mounted below U-Bolt plate:	Yes No N/A
**Refer to the measurement diagram for the following values: Measurements Page**
Depth of Round:	Left Right
Height of Front:	Left Right
Height of Back:	Left Right
Sidewall Distance:	Left Right
Remaining Thread:	Left Right
Thickness of Shock Bracket:
Bolt Diameter:
Front to Rear:
Side to Side
Thickness of Nut
Coarse or Fine Thread	Coarse Fine
Sidewall of tire to center of brake can:
Distance from lowest part of air can assembly to ground:
Distance from front U-Bolts to front of air canister
Fuel Tank in relation to canister:
If BEHIND axle: Distance from center of axle to fuel tank: If n/a, are there compartments or obstructions behind axle? Yes No
Automatic slack adjuster with disc brakes: Yes No
If yes, Disc or S-Cam: Disc S-Cam
Comments or Questions: