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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