Restoration Order Form Do you plan on having your Corvette judged?YesNoCustomer InformationName*Email Daytime PhoneHome PhoneShipping InformationShipping Address*Return Shipping Address: (must have Physical address - NO P.O. Box #) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Vehicle Information(Specify if sending 58-62 dash clusters, 64-67 consoles,etc.)Year195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982HorsepowerInterior ColorItems Enclosed Dash Cluster Assembly including gauges Tachometer Gauges Fuel Temp Battery Oil (Please do NOT remove gauges from case 53-62 models.) Clocks (1963-1982) Console Glove Box Door Glove Box Assembly Headlight Motor Wiper Motor OtherOther - Please Specify:Is this unit REPAIR ONLY (NO COSMETICS)?YesNoApplies to individual gauges only (part of a cluster). Remember, we can make your parts look new.Dash Cluster Assemblyleave key in ignition - OR - remove ignition before shipping. $15.00 charge to remove ignition cylinder if key is not provided.Do you want the odometer reset to zero if it is replaced?YesNoTachometerIs this a 1953-1961 unit?YesNoPlease Specify Drive Type:Distributor DriveGenerator DriveOdometerDo you want the odometer reset to zero if it is replaced?YesNoClocksMovement TypeStandardQuartzFor Quartz Movement (53-62 owners), we perform COSMETICS ONLY, no mechanical repairs).Headlight MotorHeadlight Motor QuantityPlease enter a number from 1 to 99.Wiper MotorWiper Motor TypeTYPE ITYPE IITYPE IIIPlease list all other comments, instructions, or requests here. Be as specific as possible. For example: red line changes, additional services, etc.CAPTCHACorvette Specialties of Maryland will make every effort to notify the customer should unexpected or unusual situations arise causing a substantial overage in your Service Fee; Remember we are working on items that are often 50 or more years old and are meant to be replaced when a failure occurs!
