* Required

VIN Number *
Name *
Address*
Apartment #
City*
State*
Zip Code*
E-Mail*
Phone Number*
Vehicle Milage*
Do you have vehicles broadcast sheet? *	Yes No
Do you have vehicles fender tag? *	Yes No
Please put fender tag info here.*
If you found a broadcast sheet to another car please put the vin number here.* (If you have'nt looked for other broadcast sheets please do so. Areas to look: Top of glove box liner - Under front seats - Backs of front seats - Under back seat bottom and under carpet and behind rear seat back. )
Do you have original engine?	Yes No
If not please list the vin number to motor in your car.
Do you have original transmission or transmission from other car? If so please list the other number or partial vin.	4 Speed Automatic Automatic On Column
Does your car still have the original factory paint job?	Yes No
How long have you owned your AAR?	Years
Have you added any options to your car?
Have you made any modifications to your AAR?
Do you know the history of your AAR?
Do you have any documentation pertaining to your AAR?
May I put your name by your AAR on the vin list?*	Yes No
Exterior Color *
Vinyl Roof*	Yes No
Interior Color*
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