This form is for ordering a Friday Nite Card to be Picked up at Cruise from Bill & Doris.

Please use this form if you wish to have the Dash Card mailed out to you. All * fields are required. Car sub model is included so that you may be more descriptive.
ie, Car Make: Chevrolet
Car Model: Corvair
Sub Car Model: Monza 900

The Car Nic Name is not required.
I have included boxes for 2 last names in the case that the car is owned by "Partners" or spouse has retained maiden name.
* Required

*Cruiser Number

   *Car Year

*Car Make

*Car Model

 Sub Car model

Car Nic Name
   

 

    

First Name/s

*    and
Last Name/s

*

 

 *City

*State *Zip Code

 *e-mail