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http://www.etrailer.com/tv-hitch-install-2003-ford-e250-van.aspx
Videos are provided as a guide only. Refer to manufacturer
installation instructions and specs for complete information.
Today on this 2003 Ford E-250 we are going to install part number 87115 from Hidden Hitch. This also applies to part number 75191 from Draw-Tite. Looking at the drivers side frame rail we will show you where the hitch installs. We are going to install using this forward hole here, this slot right below the canister, this existing hole, and also this rearmost hole here. It will be identical on both sides. :24

The first step involved is to take down the carbon canister on the frame rail on the drivers side. That will give us some working room to our bolts in. Then we can life the hitch into position. Next we will install the hardware. This is the slot we are going to use, it is going to use the carriage bolt and the plate. And we can put our canister back into place. :54

Moving closer to the bumper we can install the next piece of hardware, the hex bolt and small block. And the last hole at the end of the frame we are going to install a carriage bolt and a heavy flat washer. And then do the same thing on the other side. To put the hitch into position, what we will do is start with the forward bolts and put a nut and washer on there to hold it into place. We will work with the other hardware next. The frame rails start low here and work their way up, so we have to put some spacers in between to make up the difference. So what we will do is go ahead and put our block in, install the conical tooth washer and nut. On the rearmost hole, we will install a special washer that is a big, thin, flat washer. Once you have those installed go over to the drivers side and repeat the same process. 1:28

At this point we have all the hardware installed and started so we can go ahead and start snugging the bolts down. Now that our bolts are snugged down and the hitch is level to the frame with the spacers we can go ahead and torque down the bolts as specified in the instructions. With our hitch bolted down all that remains is it reinstall the spare tire. And that finishes our install of part number 87115 from Hidden Hitch.