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

FORM INSTRUCTIONS: Complete this form online and press the ‘Submit‘ button at the bottom of the page. On the next page you will be prompted to print this form and the accompanying Payment Information form, both of which should be included in your shipping box with your parts for restoration. If you would like to print a blank form and complete it by hand, please click here for a printable copy.

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
Do you plan to have your Corvette judged at NCRS or Bloomington type events?
- Yes
- No
What are you sending?
Items Enclosed
- Dash Cluster Assembly including gauges
- Tachometer
- Speedometer
- Gauge: Fuel
- Gauge: Temp
- Gauge: Battery
- Gauge: Oil
- Clocks (1963-1982 ONLY)
- Headlight Motor(s)
- Wiper Motor
- Glove Box Door (1964-1967 ONLY)
- Glove Box Assembly (1964-1967 ONLY)
- Console
- Wiper Switch Plate
- Other (Specify below)
1958-1962 Owners Please Note: We no longer restore the outer dash housings for 1958-1962 gauge clusters. Gauges should be left in their individual housings/pods only when sending for restoration or repair. Please do not send gauges still in the outer dash housings.
1953-1957 OWNERS PLEASE NOTE: Gauges should be left in their housings/pods when sending for restoration or repair.
Are you sending gauges for REPAIR ONLY (no cosmetic restoration)?*
Applies to individual gauges only. Remember, we can make your gauges 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. Additional charge to remove ignition cylinder if key is not provided.
Odometer Options:*
PLEASE NOTE: Zeroed odometers will still show a few miles due to testing and calibration.
- Set mileage to zero - Requires odometer replacement
- Keep existing mileage - Odometer replacement only if mechanically or cosmetically necessary
63-67 Clusters: Are you including a Headlight Motor Switch?
- Yes
- No
Speedometer
Odometer Options:*
PLEASE NOTE: Zeroed odometers will still show a few miles due to testing and calibration.
- Set mileage to zero - Requires odometer replacement
- Keep existing mileage - Odometer replacement only if mechanically or cosmetically necessary
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 Movement - As original, but prone to failure. Correct for judging.
- Quartz Movement - Much more reliable, but not correct for judging.
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
Is your Wiper Motor a 1958-1962 unit?*
- Yes
- No
Are you including a Washer Pump Vacuum Coordinator?*
Used to engage the Windshield Washers, which were optional on 1958-1960 Corvettes and standard on 1961-1962 Corvettes.
- Yes
- No
Does your Washer Pump Vacuum Coordinator need to work?*
We will clean your coordinator at no additional charge, but please specify if coordinator needs to be functional. Additional charges apply as there is a limited supply of NOS coordinators available. (We make this optional since many owners do not drive their Corvette in bad weather)
- Yes ($175 additional for coordinator replacement)
- No
Console
Console Paint Color*
The paint color we will restore on your Console.
Notes
Please list all other comments, instructions, or requests here. Be as specific as possible. For example: red line changes, additional services, etc.
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!
When complete, press 'SUBMIT' below.
You will be prompted to print your forms on the next page.

BACK IN STOCK FROM LONG BACKORDERS:

1965-1967 Side Exhaust Covers (supplies limited) Click Here to Order

1959-1962 Wheel Covers (supplies limited) Click Here to Order

1960-1962 Dash Inserts Click Here To Order

Restoration Order Form

Customer Information

Shipping Information

Vehicle Information

What are you sending?

Other - Please Specify:

Dash Cluster Assembly

Speedometer

Tachometer

Clocks

Headlight Motor(s)

Wiper Motor

Console

Notes

When complete, press 'SUBMIT' below.