ACOC
Membership - Please complete, print out the form
and return with your full remittance to:
Bob Langley, 47 John Rennie Road, Chichester, West Sussex, PO19 8FD
OR join or renew with PayPal online on our online registration page >>>>
click here.
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| Surname |
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| Forename(s) |
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| Address |
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| Postcode / Zip |
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| Telephone |
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| Email |
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I hereby apply for membership of the AC
Owners' Club Ltd and undertake to be
bound by the Memorandum and Articles
of Association of that Company. I
understand and agree that my name,
address and car ownership details may
be processed and used for Club
purposes only as stated in the Data
Protection Act Notice displayed on this
website unless requested to be
withheld.
Signature ................................................................................
Date ................................. |
Car Details (ACs only, please!)
| Year |
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Model |
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Chassis No. |
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| Present
Engine Type |
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Engine No. |
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| Reg No. |
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Mileage |
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Overdrive - Yes/No |
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| Modifications |
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Date of Purchase |
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| Condition at
Time of Purchase |
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Price Paid
(this information remains strictly confidential)
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| Colour |
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Interior |
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Gearbox type |
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Cheques made payable to: AC Owners' Club Ltd. |
TOTAL £ |
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Card Number............................................................................... |
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| Expiry Date.................................................................................. |
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| 3 Digit Security Code................................................................... |
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| Cardholder's Name...................................................................... |
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| Cardholder's Signature................................................................. |
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