Chrysler/Valiant Hardtop Registration Form

To register your hardtop, fill in the form below. It may be submitted electronically or printed (here is a more print friendly version) and sent to

Herman Coomans

Please email a photograph of the car and a *clear* photograph
of the compliance plate for validation purposes.

Car Info
Model:	CH Hardtop VH Hardtop VJ Hardtop
Year:
Body Number	(stamped into right side bonnet recess, inside the engine bay - a number between about 1 and 2500)
ChassisNumber	(This number is on the compliance plate, and will look something like VH4H23/AA99-9999.)
Original Engine	(eg 215, 265, 318, 360)
Original EngineNumber	(if known, optional)
Current Drivetrain	(eg "Original" or "340 4 speed" or "318 auto")
Other info: (options, history, wheels & tyres etc)
Date Purchased
Owner Info
Name
Email
	Include my email address in the web site listing
Phone
Address
Town,State,Pcode
Country
	Include my State and Country in the web site listing
URL

	If you submit this form electronically, you will be prompted to send an email with photographs of the car and the compliance plate attached.