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Melrose T-Top Corvette Roof Re-lensing Order Form 

Date__________________

Order# or RGA#________________________

Replace lens with- Factory Blue Tint_______ Factory Bronze Smoke Tint______ No Preference______

Replace Side Gaskets ($30ea Side)  - Yes_____  No______ 

Please contact us at any time should questions or concerns arise (815)758-2783

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Corvette Roof Re-lens service     Date__________________

Phone#____________________ Email -for tracking#_______________________________ RGA# or Order#_______________

Replace lens with- Factory Blue Tint_______ Factory Bronze Smoke Tint______ No Preference______

Replace side gaskets ($30ea installed) - Yes_____ No____ Payment enclosed _______Call me for CC# upon completion_______

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