Customer InformationName:_____________________________________________ Date:________________ Address:___________________________________________________________ City:_____________________________ State:__________ Zip:_____________ Phone #:_______________________ E-Mail:__________________________________ Block InformationBlock Serial #:____________________ Make:_________________ Model:_______________ With your BLOCK, You must include main caps, bolts and stud girdle assembly if applicable. - SUBARU - must be shipped with the case bolts !
Payment DetailsDeposit Amount ( Minimum deposit = 50% ) $ ________________ Check, Money Order or Credit Card to Larry's Auto Machine - Please Call for Quote Import Labor PricingBlock Packaging Instructions |
Contact Info Airport Business Park 175 Leonard Drive, Groton, CT 06340 860-449-9112 www.LarrysPower.com |