Brake Request Form

White Post Restorations
One Old Car Drive (For UPS)
Post Office Drawer D (For Mail)
White Post, VA 22663
Phone: (540) 837-1140

Rebuilders of master, wheel, slave, clutch cylinders, calipers, vacuum boosters, metering & proportioning valves, brake pad & shoe relining.

Be sure to include this completed page inside your package.
Please call with any questions you may have.

YOUR BRAKES BETTER THAN NEW

Year, Make and Model:
Master cylinder sleeved and rebuilt complete (Each)
Wheel cylinders sleeved and rebuilt complete (Each)
Step-bore wheel cylinders are at an additional charge (Each)
Master cylinder with vacuum booster complete rebuild
Booster with servo complete rebuild
Disc brake calipers complete rebuild
Proportioning valve complete rebuild (Each)
Your shoes relined (2 shoes per wheel)

Name:
Street:
City:
State: Zip:
Phone:
Please choose shipping method: Ground 3 Day 2 Day Next Day

Payment: Check Enclosed:
Payment (Mastercard Visa or Discover #): Exp:
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