Ricks Radio Conversions Customer Form  

Mail to;                                                                phone 757-716-9305

Ricks Radio Conversions

5724 Aura Dr

Virginia Beach VA, 23457

Name_________________________  Phone:_______________

Address:_______________________ email:________________

City:_______________________________ST____Zip_______

Year_____Make:________________ Model:_______________

-------------------- CIRCLE OPTIONS BELOW TOTAL PRICE-----------------

        FMR $400  / FMR BTU $600 / FMR BT $500 / FMR USB $500

--------------------DAUGHTER CARD OPTIONS ADD EACH-------------------

               HIGH DEFINITION $100        COURTESY MODULE $50

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                                              AUX Input Control (Circle only one)

                       Power Cycle   /  VOX   /  Low End Tuning   /   External Switch

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Paint Tuning needle  RED   ORANGE  OTHER__________________

Pre-Amplifier outputs:  SUB  / LF / RF / RR / LR  

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Indicator Bulb:  On with headlight switch (stock in some cases)    On with Radio Switch

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Shipping:  All radios are shipped USPS and insured at cost, typically $25-$30

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Speakers: All Dual Voice Coil Speakers are $55.00 plus shipping. Sizes   4x10     5x7     6x9

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** PLEASE TAKE OFF RADIO KNOBS AND LEAVE THEM AT HOME ** By signing below I do not hold Ricks Radio Conversions liable for any problems with original equipment of my radio. I understand that Ricks Radio ConversIons will do the very best to Convert my Radio with Aurora Design Products, however, if my volume, tone, or tuner controls are not within specifications I will not incur any cost and at my expense I will have my radio sent back to me. I also understand that my radio will be cleaned and polished on the outside, no re-chroming will be done. Radio will be completed as was sent in.        X______________________________________ Date: