Corvette Specialties of MD West restoration order form. Send with parts for service.

Customer Information

First & Last Name*

Email Address*

Daytime Phone*

Alt Phone

Shipping Information

Return Shipping Address*

Note: Must be a physical address - we cannot ship to PO Boxes.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Vehicle Information

Year, horsepower, judging status, etc.

Year*

Horsepower

Interior Color (If sending 64-67 consoles, etc.)

Do you plan to have your Corvette judged at NCRS or Bloomington type events?

Yes
No

What are you sending?

Items Enclosed

Please do not send 58-62 dash cluster housings. Just the individual gauge pods.

Are you sending gauges for REPAIR ONLY (no cosmetic restoration)?

Applies to individual gauges only. Remember, we can make your parts look new.

Yes
No

1963-1967 OWNERS NOTE: Please DO NOT send cluster housings that are not being restored. Due to circumstances beyond our control (i.e. chipping paint, etc.), we cannot reassemble gauge clusters without restoring the housings as well. If you absolutely do not want your gauge cluster housing restored, please remove your gauges and send them individually. Thank you.

Other - Please Specify:

Dash Cluster Assembly

PLEASE NOTE: LEAVE KEY IN IGNITION - OR - remove ignition before shipping. $20.00 charge to remove ignition cylinder if key is not provided.

Do you want the odometer reset to zero if it is replaced?

Yes
No

63-67 Clusters: Are you including a Headlight Motor Switch?

Yes
No

Speedometer

Do you want the odometer reset to zero if it is replaced?

Yes
No

Tachometer

Is this Tachometer a 1953-1961 unit?

Yes
No

Please specify drive type:

Distributor Drive
Generator Drive

Clocks

Clock Movement Type

1953-1962 OWNERS PLEASE NOTE: We can perform COSMETIC RESTORATIONS ONLY (no mechanical repairs).

Standard
Quartz

Headlight Motor(s)

Headlight Motor Quantity

Please enter a number from 1 to 99.

Wiper Motor

Wiper Motor Restoration Type

See our Wiper Motor Restoration page for details.

TYPE I
TYPE II
TYPE III

Notes

Please list all other comments, instructions, or requests here. Be as specific as possible. For example: red line changes, additional services, etc.

CAPTCHA

Corvette Specialties of MD West 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!

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