BX Register Form (PDF) - Citroen Car Club

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THE CITROËN CAR CLUB REGISTER FOR ALL CITROËN BX MODELS. Date as Postmark. Dear member. Thank you for your interest in the BX Register.
BX-TRA

REGISTER THE CITROËN CAR CLUB REGISTER FOR ALL CITROËN BX MODELS

Date as Postmark

Dear member Thank you for your interest in the BX Register. I am sure as a proud owner of the Citroën BX, you will appreciate the need for the register to exist, and of course it will become more valuable as time goes by and this great model becomes more rare. We see the purpose of the Register not only to keep an up to date record of all the cars in existence within the CCC (uk) Ltd, but we shall have a permanent record plus photo of each members vehicle (please enclose) in the event of the unmentionable occurring like theft, arson or similar evils and some body wishes to dispute your claim; Please fill in the Registration Form for the Register and we will do our best to meet your needs. Please return said form with a reasonably current photograph of the vehicle All written enquiries will be answered providing an SAE is enclosed, I might swear if the phone wakes me up after/before a reasonable hour but if it's an emergency I am a reasonable person mostly. We look forward to hearing from you soon.

regards CHRIS & JULIE BRADLEY

139 Manor Road Stechford Birmingham B33 8DH Tel / Fax: 0121 243 7091

e-mail : [email protected]

BX REGISTRATION FORM Data Protection Act: This information will be maintained in a database with Exclusive Access to Club Officers only unless you state otherwise in writing or tick here (BLOCK CAPITALS PLEASE)

CCC MEMBERSHIP No:

Name: Address:

Tel No: Reg No: Personalized ?

Model/Type Colour:

Mileage: Resprayed Y/N

Chassis No:

Engine No:

Date of Registration:

Engine Size: (cc)

Diesel :

Petrol:

Gearbox: 4 Speed

Number of Owners: ........................ Vehicle Use: (main car/spares/restoration etc) (Also include who drives if family owned)

Automatic

Manual

5 Speed

History / Condition of car:

Extras/Modifications: (eg Towball : sunroof : alarum etc)

Please send or enclose a recent photograph if you have one. Many thanks for taking the time, filling in this application form, we look forward to receiving your details. Please return to the above address. Signed: .............................................................

Date: ..................................................