Your Name:
| ____________________________________
|
Address:
City, State (Province), Zip:
| ____________________________________
____________________________________
|
| Area Code / Home Phone #: | ______ / ______ - ________ |
Area Code / Cell Phone #:
Email address:
Vehicle Identification Number:
Model (as built - Palm Beach, Eleganza, Royale, Etc.): | ______ / ______ - ________
______________________________
TZE _______ V ________________
______________________________
|
Build Date (from the decal on the glove box door
- look for a number on the top line just left of center that looks
like "032174" or something similar): | _____________________
|
| Month / Year YOU acquired this GMC?: | ______________________________ |
|
|
Previous Owner:
| ____________________________________
|
| Previous Owner City / State: | ____________________________________
|
| Any unique or unusual modifications?: | ____________________________________
|
|
|
|
|
The information you provide to the Registry is held as confidential. It is not loaned, sold, rented, etc. to any groups or entities.
Thanks for your help.
Billy Massey
7110 Forbess Dr.
Brownwood, TX 76801
|
