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RENEWAL, USA & Canada |
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RENEWAL Overseas |
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NEW, USA & Canada |
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NEW, Overseas |
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| Canadian and
overseas payment MUST be in U.S. funds drawn on a U.S. bank,
or complete the VISA/MasterCard information below. Other types of
payments WILL be returned. |
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| Please file my (our)
membership as follows: (Type or Print Plainly) |
| Name:
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Spouse's Name:
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| Mailing Address:
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| City:
State:
Zip Code:
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| Country:
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| Phone Number:
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CVA Number - If Renewal:
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| E-Mail Address:
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| How did you learn about the CVA Club?:
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If Referred by a Member, Who?:
|
List Name in Roster?
List Telephone in Roster?
List Email in Roster? |
YES
NO
YES
NO
YES
NO
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| Payment Information |
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|
VISA
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MASTERCARD
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Payment
enclosed. Please make check payable to: Crown Victoria Association, Inc. |
| |
|
| Card No.
|
Expiration Date
Note 4% will be added to total when using credit card. |
| Credit Card Three Digit Security Code:
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| Signature (Typing your name in the box constitutes your signature):
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| Please list any 1954-'55-'56 Fords/Mercurys/Trucks you own: |
| YEAR/MAKE:
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MODEL:
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| YEAR/MAKE:
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MODEL:
|
| YEAR/MAKE:
|
MODEL:
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| Condition:
|
| |
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Original
Restored |
Being Restored
Modified |
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Car One:
Serial Number:
Body Info:
Color:
Trim:
Production Code:
Car Two:
Serial Number:
Body Info:
Color:
Trim:
Production Code:
|
CAR OWNERSHIP NOT REQUIRED
Complete the Data Plate Information
(on the left) from your 1954,
1955 or 1956 Ford.
If you have more than two, contact CVA. |
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- Please
send to:
- Crown
Victoria Association, Inc.
-
National
Headquarters
-
P.O.
Box 6
-
Bryan,
Ohio 43506-9141
-
This email address is being protected from spambots. You need JavaScript enabled to view it.
|
Please
Complete ALL the Information Above.
Membership is for 12 months from
receipt of correct remittance. To be eligible for year pins and
newsletters, membership must be consecutive.
Remember to renew on time! |
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