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Any progress on this? I’m actually looking at a SRW E350 similar to this, but the UJoint kit i would want to use is pretty spendy!

If you are splashing that much back on your transmission or it's somehow blowing in there you need some sort of guard. Maybe just something to protect it from the side but not the front or rear, that way you don't inhibit movement of your linkage. Is it a cable linkage? Something you could try...

Yea I guess I was just wondering if the configuration would work, E4OD to 271, as I thought the 271 was a later model t-case. As far as getting a truck 4wd trans from the junkyard and swapping it in, would I then be able to just bolt up the 271 or does it take some special conversion output shaft?

Well I'm thinking I can buy it and throw in a used truck transmission and have $1500 in everything. That's pretty affordable! Especially considering what I see these narrow ambulances go for. So will the NV271 still just bolt up to the rear or did they use a different T-case back then?

Well all these awesome ambulance builds on here has had me looking for months for a cool project. I found a nice-ish 1993 E-350 box ambulance, Single rear wheel on Craigslist for an affordable price, possibly needing a transmission. It's been out of service for a while I believe, but reportedly...

This is an awesome build! I really like the track system for the seats. I work on aircraft and they use the same stuff to be able to change the seating arrangements for more or less legroom.