1962-1979 FENDER TAG RESTORATION
INFORMATION NEEDED:
(PRINT CLEARLY OR TYPE)
Please fill in as much information as possible.
1. Owners Name:
Address:
City, State & Zip:
Home Phone Number: Work
E-Mail Address:
SEND #2, 3 &4.
2. Copy of Title or Registration-IN YOUR NAME, Bill of Sale or Legal Proof of Ownership.
3. Pencil rubbing of Serial Number on Door Pillar (1967+Older) or Dash (1968+Newer).
4. At least one (or more) of the following items:
A. Copy of original (rusty-but somewhat readable) Fender Tag(s).
B. Copy of Broadcast Sheet and/or Original Window Sticker-prefer COLOR copy,
C. Original Dealer Invoice/IBM card/Order Form with Vehicle Order Number listed.
IF YOU HAVE ANY OF ITEMS 4, GO TO #8. IF YOU DO NOT HAVE ANY ITEMS 4 - GO TO #5.
5. Names, Addresses & Phone Numbers of 1 (or 2) known previous owners.
6. Copy of one of the following items:
A. Manufacturer's Statement of Origin, (from state DMV) or
B. Original Chrysler Invoice (From Original Selling Dealer), or
C. Donor Fender Tag from Same Year (1969 or newer), Model & Plant.
(Tag will not be returned!-Example: 1969 Road Runner=any 1969 Belvedere built @ same plant)
7. 35MM Photograph's (Or video) of the vehicle in an unrestored condition: CHECK WHEN DONE
BODY: Eye level-Drivers Side __, RH Side __, Front __ & Rear __. Rear window area __.
Secondary Body Code Numbers behind left rear bumper area __ (1966-67 B-Body only).
UNDERHOOD: Complete LH __, CTR __, RH __, UPPER __, LOWER __ firewall w/Air
Cleaner removed __, Lower Steering Column at Firewall __, Master Cylinder __, Radiator
Part Number __ = ______& Diameter of opening (19"), (22"), (26") or (28"). Power
Steering Pump __ & Gear __. Underside of hood __, Primary Radiator Support Body Code
Numbers __, Secondary Cowl Body Code Numbers __ (1970-74 E-Body & 1971-74 B-Body
only), Idle Label __ (Found on 1968 & newer vehicles), If S/S HEMI RH shock tower __.
GLASS: Windshield __, Side Windows __, Rear Window __, Get close-up of windshield
(bottom center) __ & side __ & rear window lettering w/date __. W/Shield is dated: ____.
INTERIOR: Complete dash top __, gauges __ & bottom __. VIN on door pillar or dash __,
Dash w/speedometer & gauges __, Radio __, Front __ & rear seats __, 6-Way? __,
Door panels __, Headliner __, Door VIN Decal ('69 DAYTONA only) 1970 & Newer __,
Tire Label __, Original body paint on passenger floor under carpet __.
Secondary Body Code Numbers on package tray __ (1965 & older models, 1970-71 Duster).
Interior complete firewall if 1962-64 MAX WEDGE or 1964-68 S/S HEMI __.
TRUNK: Underside of lid __, Spare Tire/Wheel __, Spare tire mounting area on '70-71
E-Body Original paint on rear speaker panel __, Secondary Body Code Numbers on LH
trunk lip under weatherstrip __(1968-70 B-Body, 1970-71 Dart), Bumper Jack Assy __,
Battery mounting area if MAX WEDGE or S/S HEMI __.
Page 1 of 1
CHASSIS: Bottom of K-Frame __, '70 & newer coin # on K-frame __, Front brakes __ &
diameter- 9", 10" or 11" (Circle one), rear brakes __ & drum diameter- 9", 10" or 11".
FT & RR Shock Numbers: (Optional),
LH & RH Leaf Spring Numbers: , Sure Grip?
8 3/4" 3rd Member Casting Number: 2070741, 2070742, 2881489 (LH Side of carrier),
Rear axle tube-front __, and rear __, Axle Ratio tag __, Chassis-rear of front tires __,
Front of rear spring mounting area __, Rear of rear spring mounting area __,
Frame and body above axle assembly__. (Rubber Bumpers & pinion snubber)
Every square inch of underbody if MAX WEDGE or S/S HEMI-including wheel wells __,
and Parking Brake Cables.
8. Return this inquiry with amount due: call if prices are not circled below! (A, B or C + S&H=Total)
A. Fender Tag Assembly/If you have a rusty Fender Tag. $ 110.00
OR
B. Fender Tag Assembly/If you have a readable Broadcast sheet. (Decoding incl.) $ 165.00
OR
…MINIMUM FEE REQUIRED…
To review Fender Tag order, if only a partial Broadcast Sheet, add $ 25.00
OR
Plus the next items if needed---Check with GTS first. PLUS
For 2nd TAG (IE: Well optioned car, TRANS AM, HEMI FENDER, etc). Add $ 60.00
Plus DONOR TAG (See 6C) 1969 & newer only -if needed $ 50.00
Plus FENDER TAG SCREWS (Used pair - if needed) $ 10.00
All US orders are shipped to customer via 3 day-Federal Express S&H= $ 16.00
International or Canada Orders shipped Registered US Mail $ 20.00
RUSH FEE/2 WEEK TURNAROUND TIME $ 100.00
Total = $
“CORRECT” FENDER TAG (s) WILL BE IN STEEL AND ARE EXACT REPLICAS OF THE ORIGINAL.
All orders checked for accuracy & authenticity. VIN: .
Body Codes found on Radiator Support: .
CHECK, M/O or CREDIT CARD # Exp. Date
NAME ON CREDIT CARD
Galen’s Tag Service, LLC.
Galen V. Govier
PO Box 516
Prairie du Chien, WI 53821-0516
(608) 326-6346 VOX
(608) 326-8061 FAX
www.gvgovier.com
Thank You (Please return this form to G.T.S with order) 07/01/2007