© Long Roof Registry

CHEVROLET LONG ROOF WAGONS REGISTRY
Certificate of Registration

LONG ROOF WAGONS REGISTRY © - All Rights Reserved
Credit Cards accepted are Visa, Mastercard, American Express, and Discover.

Note: The information entered is not checked for validity - please make sure card number/cvv is entered correctly.

 

Your email address for receipt confirmation
(youremail@yourhost.com)

Your order will be processed without a valid email address but you will not receive a confirmation receipt from the Long Roof Registry.
   
Select your purchase (Check One)
 Standard Certificate - U.S. Mailing Address - $27.95
 Standard Certificate - Canada Mailing Address - $42.95
 Custom Certificate - U.S. Mailing Address - $32.95
 Custom Certificate - Canada Mailing Address - $47.95

   
Add $9.00 for U.S. Priority Mail ? Choose one →  YES - Add $9.00 for U.S. Priority Mail
 No - Do not add $9.00 for U.S. Priority Mail
   
Add $4.00 USPS with tracking number?  YES - Add $4.00 for USPS with tracking number
 No - Do not add $4.00 for USPS with tracking number
   
Frame Color
 Gold
 Blue
 Green
 Maroon
 Red
   
VIN of the 300 Wagon for confirmation
   
Name(s) to appear on certificate
(Exact spelling and capitalization)
   
Ship to Address (1)
   
Ship to Address (2) (if needed)
   
Ship to City
   
Ship to State/Province
   
Ship to ZIP/Postal code
(xxxxx), (xxxxx-xxxx), (xxx xxx)
   
Phone Number (optional)
   

Card Information

 
Card Type (Check One)
 VISA
 MASTERCARD
 AMERICAN EXPRESS
 DISCOVER

   
Card Number
(xxxx-xxxx-xxxx-xxxx) or (xxxxxxxxxxxxxxxx)
   
CVV Code on back of card
(xxx)
   
Expiration Date (mm/yy) (xx/xx)
   
Billing ZIP/Postal code of cardholder
(xxxxx), (xxxxx-xxxx), (xxx xxx)