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1965 396 Corvette Registry Enrollment Application

Please submit one full application for every vehicle owned.
Please note that fields denoted by asterisks are required.

First Name*

Last Name*

Address

Suite/Apt

City

State

Zip

Daytime Phone #

Evening Phone #

Fax #

Cell Phone #

Email*

Please see privacy statement.

Model

 

 Power Steering

Transmission

 

Power Brakes

Top

 

Power Windows

Wheels

 

 Side Exhaust

Tires

 

How long have you owned your big block? (MM/YY)

What is the VIN?

What is the mileage?

Do you have documentation on the mileage?

 

 

Does your big block have the following factory documentation:

 

   • Original Bill of Sale?

   • Protecto-Plate?

   • Tank Sticker?

   • Window Sticker?

   • Car Shipper Invoice?

   • Factory Invoice?

 

 

Does your Corvette still have original paint?

If painted, is it still the original color?

What is the paint code for your Corvette? (i.e. 976 or UU)

Does your big block still have the original interior?

Is the interior color still the original?

What is the interior trim code of your Corvette? (i.e. STD or 407)

Does your car still have the original motor?

   • If no, is it a restoration motor?

What is the Tonawanda number? (i.e.T0328)

What is the engine suffix? (i.e. JE)

What is the block casting number?

What is the block casting date?

Is the corresponding serial number on the engine pad?

   • If so, what is it? (i.e 7112345)

 

Has your Corvette been restored?

Has your Corvette been frame off restored?

 

 

Has your Corvette been judged?
Select those that apply.

 

   • NCRS Chapter meet?

   • NCRS Regional meet?

   • NCRS National meet?

   • NCRS Performance Verification?

     • What year?

   • NCRS Duntov?

     • What year?

   • Bloomington?

     • What year?

Any other judging?

 

Any other interesting notes or highlights?