Note: By signing this agreement, you are also agreeing to my
Terms and Conditions as stated on the "Terms" page of this
website. You are also agreeing to pack your items EXACTLY
as shown on the "Packing" page. YOU MUST REMOVE AND
KEEP ALL KNOBS AND MOUNTING BRACKETS.
Shop Name (if applicable) __________________________________________________
Shop Phone (if applicable) _________________________________________________
Customer Name __________________________________________________________
Customer Phone _________________________________________________________
E-Mail __________________________________________________________________
Return Shipment Address _________________________________________________
City, State (or Province) ___________________________________________________
Zip or Postal Code ________________________________________________________
Country(if not U.S.) _______________________________________________________
Type of Unit(s) ___________________________________________________________
Problems Noted When Operating ___________________________________________
________________________________________________________________________
________________________________________________________________________
Vehicle Year, Make and Model ______________________________________________
Unit Model and Serial (if known) ____________________________________________
------------------------REPAIR OPTIONS --------------------------
NOTE: Most radios can no longer be safely and reliably repaired
to "original stock", and customer MUST be willing to convert
to modern electronics if necessary. Please circle your first
choices from the following options.
Solid State AM Radio, Repair to Original .................................................................. 295.00
Tube Radio, Repair to Original ....................................................................NOT OFFERED
Delco T-200 8 Track Player, Repair to Original ......................................................... 365.00
Delco T-400 8 Track Player, Repair to Original ......................................................... 295.00
Aftermarket Standalone CAR 8 Track Player ............................................................ 195.00
Aftermarket Combination Radio/8 Track ................................................................... 249.00
HOME 8 Track Unit (Price shown for your basic type of unit) ....................... $ __________
------------------- CONVERSION OPTIONS ---------------------
FM Conversion and Power Upgrade, Solid State AM Radio ..................................... 415.00
Conversion, Solid State AM-FM Radio ...................................................................... 415.00
Conversion, Combination Radio/8 Track (SINGLE Unit) ........................................... 549.00
Conversion, SEPARATE Radio and 8 Track (TWO units) ......................................... 749.00
Delco T-200 8 Track, Convert For Use With a Modern Radio ................................... 365.00
Delco T-400 8 Track, Convert For Use With a Modern Radio ................................... 295.00
TUBE RADIO, FM Conversion and Power Upgrade .................................................. 445.00
Car is NOT 12 Volt, Negative Ground ................................................................... add 75.00
ALL RADIOS - Tuner hard to turn, and/or station preset buttons not working ..... add 30.00
-------------------- ADDITIONAL OPTIONS ----------------------
Bluetooth ............................................................................................................. add 149.00
USB Reader ........................................................................................................ add 125.00
Add Both Bluetooth and USB .............................................................................. add 225.00
HD Radio ............................................................................................................. add 125.00
NOTE: An Aux input is added to all conversions at no additional charge.
--------------------------- CLEARANCE -----------------------------
Please draw a picture showing the best place to mount jacks for Aux Input. Location will
also depend on internal clearances, so please indicate both first and second choice:
--------- Original Connectors - or New Harness? ----------
Note that a conversion delivers a HUGE increase in output power, but ONLY
if the speakers are fully isolated with each speaker having its own dedicated
pair of wires, with NO wires grounded or shared with any other speaker. You
should also replace your speakers with ones capable of handling 30 watts
RMS (or 60 watts "Peak" depending on the manufacturer's rating system).
Use Original Connectors (Requires More Parts and Labor) ........... add 30.00
Install New Harness ....................................................................... No Charge
------------ How Soon Do You Need it Back? ----------------
LEVEL ONE - No additional charge. Customer is NOT ALLOWED to interrupt
my work with status inquiries, and must monitor his unit's place in line on the
Job Status page. I am unable to make ANY guesses on completion time, which
is typically several months.
LEVEL TWO - Guaranteed 6 to 8 week turnaround ......................... add 149.00
LEVEL THREE - Guaranteed 3 to 5 week turnaround ..................... add 295.00
------------------- PAYMENT INFORMATION --------------------
If desired, you can include your credit card numbers to save time on the phone.
Your card will be charged for the full amount on the day your job arrives:
CARD NUMBER _________________________________________________________
EXPIRATION DATE _______________________________________________________
Note: I DO NOT NEED THE 3 DIGIT SECURITY CODE ON BACK OF CARD
Reminders Before Packing Your Unit
Remove and keep your knobs (not the station preset buttons)
Remove and keep all mounting brackets
Record model and serial number BEFORE packing unit
Do not send newly rechromed faceplates
I have read, understand and fully agree to the Terms and
Conditions as stated on the "Terms" page of this website.
Customer Signature __________________________________________
