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Late 70s Wiper Bushing Re-pop Order Form
Name: __________________________________________________________
Address: _________________________________________________________
Telephone: _______________________________________________________
Make, Model and Year of Car: ________________________________________
Do you want the parts color tinted? ____________________________________
Email: ___________________________________________________________
Number of Sets Requested: ________@ $50.00 per set plus $5.50 USPS Priority Shipping.
Cap Only :_________@ $25.00 per unit plus $5.50 USPS
Priority Shipping
Total Amount Enclosed: _____________
Payment must be made using a United States Postal Money Order.
By signing below you acknowledge the following:
These parts were reproduced using an original NOS (New Old Stock) parts originally made for Chrysler Corporation. The process used includes silicone molds and plastic resins currently available in the marketplace. Because of the nature of this endeavor, and the fact that you will be responsible for assembly and installation, there can be no warranty of said parts. Also, because these parts are hand made, there may be some imperfections in the casting (i.e., air bubble remnants) but I will not send you any parts that I feel would be inferior to the task for which they are produced. Finally, orders will be filled ASAP on a first come, first served basis.
Signature: ________________________ Date: _________________
Please mail this form and your payment to:
Scott Verbrugge
807 Lincoln Road
Grosse Pointe, Michigan 48230
** Items not included are Wiper Link, Torsion Spring, and White Lithium Grease.
An email will be sent when your order arrives and again when your order is mailed.