Customer Information
Name:_______________________________________________________ Date:________________

Address:_________________________________________________ Due Date:________________

City:_____________________________________ State:__________ Zip:_____________________

Phone #:___________________________ E-Mail:_________________________________________

Block Information
Block Serial #:______________________ Make:______________________ Model:___________________

  • AEBS T-Sleeve Installation, w/ Bore, Hone & Deck:                     Yes                No
  • Darton M.I.D. Sleeve Installation, w/ Bore, Hone & Deck:           Yes                No
  • Darton Flanged Sleeve Installation, w/ Bore, Hone & Deck:         Yes                No
  • Straight Sleeve Installation, w/ Bore, Hone & Deck:                      Yes                No
  • Block O-Ringing (Additional Fee):                                                    Yes                No
  • Align Bore/Hone Main Bearing Saddles (Additional Fee):              Yes                No

    • Payment Details

     Deposit Amount Included (Minimum deposit = 50%): $_____________________________

    Larry's Auto Machine

    175 Leonard Drive
    Groton, CT 06340

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