Please use this Parts Registration form when sending units for service

Please read carefully and fill in all applicable areas. Your jobs will be delayed if form is incomplete.
Fill out the form, select print and include the form with your parts.

Personal Information

Name:
Return Shipping Address: (must have Physical address - NO P.O. Box#)
Address:
Address:
City: State: Zip:
Daytime Phone: (IMPORTANT we may need to call you) Home Phone:

Payment Info: Please note : Do Not send payment with items.
If complete credit info is not provided, we will ship COD or money order.
COD (All CODs are payable by money order or cashier's check unless prior arrangements are made. No cash or personal checks will be accepted)
Credit Card
* in an effort to prevent fraud, credit card processing now requires 3-digit security code located on the back of card in the signature box area.

Master Card Visa Discover
Card Number: - - - Expiration Date:
3-Digit Security Code
Name exactly as it appears on the card:

Credit Card Billing Address : (Address where you receive your statement)

Vehicle Information

Year: Horsepower:
Interior Color: (Specify if sending 58-62 dash clusters, 64-67 consoles,etc.)

Check here if you plan on having car judged at NCRS or Bloomington type events.

List Items Enclosed

Dash Cluster Assy. Including gauges (leave key in ignition - OR - remove ignition before shipping. $15.00 charge to remove ignition cylinder if key is not provided)
Tachometer (if including 53-61 unit, please specify drive type: Distributor Drive Generator Drive)
Speedometer
Gauges Fuel Temp Battery Oil (Please do NOT remove gauges from case 53-62 models.)
Clocks 63-82 Standard Movement Quartz Movement (53-62 owners we perform cosmetics ONLY, no mechanical repairs)
Console
Glove Box Door Glove Box Assembly
Dash Insert 58-62
Horn (Quantity)
Headlight Motor (Quantity)
Wiper Motor Type I Type II Type III
Radio Repair only Repair with cosmetics Cosmetics only
Other:

Specify if unit is a REPAIR ONLY - NO COSMETICS.
Applies to individual gauges only (part of a cluster). Remember, we can make your parts look new.

Additional instructions or comments:

Please list all other requests such as red line changes, additional services, etc. Please be specific:

**Print out this form and include it with your parts **

PLEASE PACKAGE SECURELY, INSURE AND SEND YOUR ITEMS TO:

Corvette Specialties of Maryland, 1912 Liberty Road, Eldersburg, Maryland 21784

Corvette 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 40 or more years old and are meant to be replaced when a failure occurs!

 

Copyright 2001 Corvette Specialties of MD, Inc.
Reproduction of this site in whole or in part is prohibited without the expressed written permission of Corvette Specialties of MD, Inc.