This is the form to register your car in the 1970 to 1971 E-Body registry. Please fill out this from as completely as you can. I am interested in what ORIGINALLY came on your car, you can describe what is currently on the car in the condition section. Print this out and send it in!
VIN _______________
Personal Information
Member(s) Name _______________
Member Address __________________
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Member e-mail address ______________________________
Member Phone Number _____________
Do you want me to keep this info confidential? Circle one: Yes / No
Vehicle Information
Mileage _______
What condition is the car currently in? (Please include any modifications from stock) ________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________
What documentation do you have for the car? Circle as applies: Fender tag / Build Sheet / Warranty Card / Consumer Information / Window Sticker / Other__________________
Can you provide a pencil rubbing of the fender tag(s) and/or copies of the documentation? Circle one: Yes / No If you can, please provide at your convenience.
Do the numbers match on the car? Circle which is original: Engine / Transmission
What color is the car? Exterior __________________ Interior __________________
Write down you fender tag(s) below:
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What other options does your car have? _______________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
How did you hear of the registry? ____________________________________________
Gary Hergert
c/o E-Body Registry
16231 194th Ave NE
Woodinville, WA 98072
Phone: (425) 788-3209
Version 1.1 11/99
