STEREO CONVERSION ORDER FORM Please print, fill out, and enclose with radio when you send it. If multiple sets, fill out a form for each.

STEP ONE: Who you are. (Rest assured, we do not solicit, nor share information. We need to know where to ship it, that’s sort of important! Please print legibly, that’s important too!) Name: __________________________________________________________________Business Name: ______________________________________________________________ Shipping Address: ______________________________________________________________________________________________________________________________________ Phone: __________________________________________________ E-Mail: ______________________________________________________________________________________ Check here if local pick-up: _______

STEP TWO: What you need: Yes, it’s a conversion but please check off the options you want. Year, Make, Model: _______________________________________________________________________________ Voltage: ___________ Polarity: ______________ All post 1956 US vehicles are 12 volts negative ground. For older models and some European, voltage and polarity may be different. Still original or converted? We need to know.. Options: Bluetooth Options: ________ BTU Smart -- Includes Smart Bluetooth and USB ($260) ________ BTL Smart -- Smart Bluetooth ($200) (Not available with HD Radio) ________ BTC/BTL -- Regular Bluetooth ($170) Other Options: ________ HD Radio -- Digital Radio (or DAB/DAB+ if configured for European Tuning) ($120) ________ CM-1 Courtesy Module -- 12v only -- radio plays until door is opened ($75) ________ Line Level Outputs for amp/powered subwoofer ($15) ________ Tube Emulation -- for older tube radios, set warms up gradually ($20) ________ Auto Volume Control -- for 57 Thunderbird with original ignition ($20) ________ VOX Input Mode (Default is tune to the left) (No Cost Option) ________ HPC Booster -- If you don’t have 12 volts negative ground, you need this! ($100) Additional Instructions: (Must be approved in advance) _______________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________