SCOA Membership Application

1996 Model Year

( PLEASE PRINT LEGIBLY )

Please tell us about yourself:

NAME:

ADDRESS:

CITY:

STATE:

ZIP:

COUNTRY:

HOME PHONE:

WORK PHONE:

EMAIL:

To fully register your Cobra, we will need:

1. A copy of the SVT owner's certificate that you received from SVT.

Didn't get one? Call SVT at 1-800-FORD-SVT with your Cobra's VIN and request one. Tell them the SCOA sent you!

If you have a 1996 Mystic Cobra, please include the separate production number as well.

2. A full copy of your window sticker, including the dealer info in the lower left hand corner.

(A reduced size copy is OK)

Don't have a window sticker? Don't despair! Just send us your VIN, exterior color, interior color and upholstery type with the following information, dependant on the year of your Cobra:

YEAR: 1996

VIN:

EXTERIOR COLOR:

INTERIOR COLOR:

UPHOLSTERY TYPE:

Convertible Top Color:
	(Circle One)
PEP Package (Leather Seats, AM/FM/CD/Cass. with Mach 460, Total Anti-Theft System)	Yes	No
California Emissions	Yes	No
High Altitude Package	Yes	No

Note: if cloth interior, please list ALL options on Cobra on separate page.

3. Purchase Information

Name of Dealer or Seller you purchased from:

Location / State of Dealer or Seller you purchased from:

Name / Location / State of original Ford dealership:

Mileage at Time of Purchase:

Date of Purchase:

While nice to have as extra documentation, the following items are not mandatory:

1. A copy of any build sheet found in your Cobra.

2. The codes off your body buck tag, which is a 4"x2" metal tag, painted body color, that is reverse stamped with codes pertaining to the build of your Cobra, and attached to your Cobra with a staple.

The tag is usually stapled to the front side of the radiator support behind the driver's side headlight, but could also be located further down by the frame rail.

If you are able to find it, please enter the codes here:

____________________________________________________________

3. The codes off of your door certification label.

Please fill in the appropriate template for your year Cobra:

1996

Date:

GVWR:

Front GAWR:

Rear GAWR:

DSO:

EXT PNT:

BDY:

BRK:

MLD:

INT TR:

TP/PS:

R:

Axle:

TR:

SPR:

4. The names of the engine builders off the tag on the passenger side valve cover.

________________________________________

5. Code from calibration label located on the driver's side door post.

6. When completed, send this application and your $15 membership fee to:

Robert Lyons
11 Netherwood Avenue
Piscataway, NJ 08854

732-457-8818 (evenings)
bob.sue.lyons@worldnet.att.net

NOTE: The SCOA does not have membership cards. The first response from the SCOA for most members will be receiving the quarterly issue of VENOM. The only exception is if merchandise or decals are ordered which will be shipped depending on availability.