CVA Online Application Form

To print this form, right-click and select print
RENEWAL USA, CANADA RENEWAL OVERSEAS
NEW USA, CANADA NEW OVERSEAS
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.
Please file my (our) membership as follows: (Type or Print Plainly)
NAME: SPOUSE'S NAME:
MAIL ADDRESS:
CITY: STATE: ZIP CODE:
COUNTRY:
PHONE: CVA NO. IF RENEWAL:
E-MAIL ADDRESS:
HOW DID YOU LEARN ABOUT THE CVA CLUB?:
IF REFERRED BY A MEMBER, WHO?:
LIST NAME IN ROSTER YES NO
LIST TELEPHONE IN ROSTER YES NO
LIST E-MAIL IN ROSTER YES NO
VISA MASTERCARD
Card No. Expiration Date
Note 4% will be added to total when using credit card.
Credit Card Three Digit Security Code:
Payment enclosed. Please make check payable to: Crown Victoria Association, Inc.
Signature (Typing your name in the box constitutes your signature):
PLEASE LIST ANY 1954-'55-'56 FORDS/MERCURYS/TRUCKS YOU OWN:
YEAR/MAKE: MODEL:
YEAR/MAKE: MODEL:
YEAR/MAKE: MODEL:
CONDITION:
ORIGINAL
RESTORED
BEING RESTORED
MODIFIED

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.

Please send to:
Crown Victoria Association, Inc.

National Headquarters

P.O. Box 6

Bryan, Ohio 43506-9141

cvaoffice@thecvaonline.com

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!