THE DAIMLER ENTHUSIASTS CLUB

MEMBERSHIP FORM & CHASSIS REGISTER

NAME___________________________________________________________ OUR REF________

ADDRESS___________________________________________________________________________________

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POST CODE____________________________________E-MAIL______________________________________

PHONE No_____________________________________FAX No______________________________________

MAKE_________________________________________MODEL_____________________________________

REGISTRATION No______________________________YEAR_______________________________________

CHASSIS No____________________________________ ENGINE No_________________________________

BODY No_______________________________________BODY TYPE: (e.g. DQ 450)____________________

BODY COLOUR/S________________________________INTERIOR COLOUR/S_______________________

POWER STEERING YES/NO (delete as necessary) CONDITION________________________________

ROADWORTHY YES / NO (delete as necessary) LAST USED ON THE ROAD__________________

PRICE PAID_____________________________________.POINTS OF INTEREST_______________________

ANY INTERSTING HISTORY*__________________________________________________________________

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*IF ADDITIONAL SPACE IS REQUIRED PLEASE WRITE ON REVERSE OF THIS FORM

ANY OTHER DAIMLER MODELS LIST HERE___________________________________________________

A PHOTOGRAPH FOR RECORD WOULD BE APPRECIATED IF AVAILABLE (MAY BE USED FOR THIS SITE)

DATE________________________________________ EXPIRY DATE______________________________

ANNUAL SUBSCRIPTION : UK MEMBERS £20 OVERSEAS MEMBERS £25 (BANKERS DRAFT/CHEQUE)

 ( For first year only)

(Delete as necessary) UK MEMBERS £18 OVERSEAS MEMBERS £24 (Standing Order Rate 

                                                            ( For Second Year to members ONLY)

Please return to: MR J. NASH, 100-102 FAIRMILE ROAD, CHRISTCHURCH, DORSET, BH23 2LN.

PLEASE MAKE OUT ALL CHEQUES TO: THE DAIMLER ENTHUSIASTS CLUB

NOTE: ALL INFORMATION IS KEPT CONFIDENTIAL, & IS ONLY USED TO KEEP THE REGISTER UPDATED.

THANK YOU FOR YOUR HELP.

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FOR OFFICE USE ONLY - iNTERNET fEB’ 04

MSC CLUB CARD SPARES LIST

MSL LETTERS SPARES UPDATES

CHASSIS REGISTER NEWSLETTER SPARES ORDER FORMS

STANDING ORDER FORM FUEL FORM SPARES LOAN

INSURANCE FORM