The Challenger T/A Registry - Membership Form
The goal of the
Challenger T/A Registry is to provide an organization for T/A owners and the admirers of
these cars. Through the registry we will collect information about T/As and use it to help
the members when possible. This includes matching up found broadcast sheets, other
paperwork or serial numbered components such as fender tags, engine blocks and
transmissions We will also do what we can to aid members in the restoration or
preservation of his or her T/A. Since Chrysler Corporation chose not to keep records on
these cars, creating a database to try and accurately record the information on these cars
for historical purposes is one of the major functions of the Registry. Please fill out the form below as completely as
possible and mail it to me at the address above.
Member data -
Personal information will not be given out.
Name_______________________________________________________________________
Mailing
Address______________________________________________________________
City
___________ State or
country___________ ZIP or postal
code__________________
Phone number
_________________________ Email address___________________________
Vehicle
identification number - (VIN) JH23 J0B _ _ _ _ _ _
Current
mileage____________________________________________________________
Current
condition ___________________________________________________________
Do you have the
vehicles broadcast sheet? Yes__ No__ If yes, please attach a photocopy.
Did you find a
broadcast sheet in your car for a different car? Yes__ No__ If
yes please attach a photocopy.
Have you looked? If not, please do!
Do you have any
original dealer paperwork for your T/A? Yes __ No__
If yes, please enclose photocopy.
Is your fender
tag still present? Yes__ No__
If yes, please include a legible pencil rubbing.
Do you have the
original T/A engine? Yes__ No__
If you have a
non-matching T/A engine, what is the V.I.N.# on the block?________________
Is your T/A
still painted its original color? Yes__ No__
How long have
you owned your T/A?__________________________________________
Have you added any factory options to your
T/A? Please list them:
Have you made
any other modifications to your T/A?
VEHICLE DATA -
Start by WRITING in the information on your fender tag below. (please send rubbing also)
Line 6: (if
needed)__________________________
Line
5:_______________________________
Exterior color____________________
Line
4:______________________________
Interior color(s)__________________
Line
3:______________________________
Line
2:______________________________
Line
1:_______________________________
CHECK OFF ITEMS
BELOW AS THEY APPLY TO YOUR T/A or AAR.
4 speed with
console ___ 4 speed, console delete___
Slapstick Automatic ___ or Column shift Automatic ___
3.55 sure grip ___ or 3.91 sure grip ___.
TOP - matching
paint___ Non matching paint (two tone)___ VINYL TOP: Boars grain___ Gator grain___
Sunroof___
Vinyl seats___
Cloth seats___ Leather seats___ Bench seat___ Bucket seats___ 6 way adjustable___
Single racing
mirror___ Dual racing mirrors___ Rallye gauges___ Standard gauges___ Manual steering___
Standard power steering___ Fast
ratio power steering___ Standard
steering wheel___ Partial horn ring
steering wheel___ Rim blow steering
wheel___ 15X7 black steel wheels with
hub caps___ 15X7 Rallye wheels___
Light Package___ Rear window louver
package___ Rear shoulder belts___ Deluxe seat belt package___ Center Console___ Floor mats___
Defogger___ Variable speed
wipers___ Pedal dress up___ Undercoating___
Front chin spoilers___ Headlamp
time delay___ Door edge moldings___ Wheel lip moldings___ Bumper guards
front
and rear___ California emissions___ Power windows___ Rear speaker(s)___ Tinted windshield only___ Full tinted glass___ AM Radio___
FM Radio___ FM/8track___ Dictaphone
recorder___ Dealer installed A. C.___
OTHER OPTIONS
NOT LISTED ABOVE:
Is there any
thing else you want me to know about your T/A or AAR?
Mail to:
Challenger T/A Registry
Barry Washington
Box 9632
Ketchikan, AK.99901-4632