D&M Restoration
STEREO CONVERSION Information FORM
Please fill out this form and include it with your radio.
Name: _____________________________________________________________
Address: ___________________________________________________________
City: _______________________________ State: _______ ZIP: ______________
Phone: ______________________
E-Mail: ______________________________________________________________
Year / Make / Model of Vehicle:
____________________________________________________________________
Voltage: 12volt / 6volt Polarity: Positive Ground / Negative ground
________ 4.1 Line Outputs
________ BT-2 Bluetooth Module w/ Voice Command, Voice Assist
________ USB-2 USB/MP3/AAC Adapter
________ BTU-2 Bluetooth AND USB
________ HPC-1 Power booster (Required for vehicles without 12v negative ground available)
Additional information/instructions: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________NOTE: Special instructions regarding conversion MUST be approved in advance! PAYMENT INFORMATION: (We will call you with an estimate before work starts – We Require A Credit Card Number upfront before beginning work)