Modified Kart Engine Information
A copy of your responses will be emailed to you. Please print this email and keep it with kart/engine for presentation to tech officials at track.
Email address *
Have you submitted a Modified Kart Engine Builder Agreement (if no, this must be done before filling out this document)? *
Approved Engine Builder Name *
Your answer
Driver Name *
Your answer
Engine Make and Type *
Your answer
OEM Engine Serial Number *
Your answer
LOORRS Seal Serial Number *
Your answer
What manufacturer is the piston in this engine (JE or OEM)? *
Your answer
What year and model engine are the cams used from? *
Your answer
What year and model engine are the valves in this engine from? *
Your answer
Date Sealed *
MM
/
DD
/
YYYY
I certify on penalty of disqualification from engine builder program that this engine meets all engine rules as specified in the current LOORRS/LORORS Kart Rule book as of the date I installed the seal. *
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