COMPONENT COBRA:
CSX1 CSX4        CSX7        CSX8
 

Please note:
 This form will not give you information about a particular car, but is for "owners" to report ownership or changes.

NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE:
E-MAIL:
TODAY'S DATE:

 

Please note: addresses and phone numbers are for internal club use only. Only name, city and state (or country) appear in the Registry. If you would like your name withheld from the next edition of the Registry please check this box.


ORIGINAL DEALER (if known):

COMPLETED BY:    DEALER        OWNER

SPECIAL MODEL
COMPETITION   TERLINUA    BILL ELLIOTT    75th ANNIVERSARY
OTHER 

BODY
FIBERGLASS    ALUMINUM        CARBON FIBER

ORIGINAL COLOR  STRIPES 

INTERIOR   

ENGINE
427 SIDE-OILER    OTHER     BUILT BY 

1X4V    2X4V

SHELBY BLOCK - SERIAL #
SHELBY-BUILT ENGINE - SERIAL #

TRANSMISSION            SUPPLIED BY   

REAR AXLE RATIO   

SHELBY OPTIONS
  ALUMINUM DRESS UP KIT
  OVER-RIDERS
  FINISHED WHEEL WELL EDGES
  FRONT BUMPER LOOP
  REAR BUMPER LOOP

CONVENIENCE GROUP
  SOFT TOP BOWS
  SIDE CURTAINS
  TONNEAU COVER
  HEATER/DEFROSTER
  LEATHER INTERIOR

PERFORMANCE GROUP
  DIFF COOLER KIT
  OIL COOLER
  CLUTCH SLAVE CYLINDER
  TRIGO WHEELS      HALIBRAND/ALUMINUM      HALIBRAND/MAGNESIUM
  ALUMINUM KNOCK-OFFS      STAINLESS STEEL KNOCK-OFFS
  ALUMINUM 42-GAL FUEL CELL
  SPUN ALUMINUM SIDE MIRROR
  SIMPSON SHOULDER HARNESSES  OTHER
  4-POINT    5-POINT   DRIVER SIDE ROLL BAR BRACKET
  COOLANT PIPES      EXPANSION TANK    PUKE TANK
  SPEEDOMETER REVERSOR

DEALER OPTIONS
  CARB PLENUM
  PUKE TANK
  EXPANSION TANK
  QUICK JACKS - FINISH
  GLOVE BOX
  KILL SWITCH
     HEADERS/SIDEPIPES - FINISH
  ROLL BAR - FINISH
  FIRE EXTINGUISHER
  DRY SUMP
  REMOTE FILLER
  ALARM SYSTEM


PRESENT CONDITION: 5. undergoing restoration
1. original/unrestored 6. wrecked
2. original/restored 7. destroyed
3. modified/unrestored 7. parted-out
4. modified/restored 9. rebodied


THIS IS NEW INFORMATION TO SAAC (as far as I know)
THIS IS A CORRECTION FOR THE 1997 REGISTRY
THIS IS AN ADDITION FOR THE 1997 REGISTRY
I DON'T KNOW IF MY CAR HAS BEEN IN A PAST REGISTRY


PAST OWNERS: Please list from first to present in chronological
order (use question marks to indicate unknown owners).


INDIVIDUAL HISTORY: Include anything unique to this car or its
owners; keep them in chronological order.





Your information will be e-mailed to the registrar

COMPONENT COBRAREGISTRAR:
KEVIN ROGERS
PO BOX 2047
ELIZABETH, CO 80107
EMAIL 4000registrar@saac.com