Kinglake Phoenix Payments

I want to be a member of Kinglake Phoenix Rod & Custom Club

Please complete the form below to become a club member.

After Registration, Your car "MUST" be inspected to make sure
it complies with Club Guideline issued by Vic Roads

If you already have and account, please to login

If you have any questions regarding registration. Please call Ray on 0488 424 205

Personal Details (For Vic Roads and Club Mailing Use)
First Name		Last Name
Email Address		Date of Birth
Drivers License #		Occupation
Address Details (For Vic Roads and Club Mailing Use)
Street Name & Number		Suburb
Post Code		Phone (home)
Phone (mobile)
Vehicle Details (For Vic Roads Use)
Make		Model
Year		Colour
Body Type		Seating Capacity
Outside Wheels		Compliance Plate Date
No. of Cyclinders/Rotors		Engine capacity
Engine Number		Chassis Number
Engine Type		Fuel Type
Transmission		Left Hand Drive
Tare (kg)		Manufactureer GVM/GCM (kg)
Road Worthy Certificate (For Vic Roads Use)
RWC Number		RWC Issue Date
RWC Tester Number
VASS Certificate (For Vic Roads Use)
VASS Number		VASS Issue Date
VASS Signatory Number
Please Note : All car registrations are subject to approval by inspection and must be accompanied by a Road Worthy Certificate and proof of ownership. (engineers report if applicable). A Kinglake Phoenix Rod & Custom Club representative will inspect your vehicle at Unit 7/24 Brand Drive Thomastown (map) for $50 or at your garaged address for *$150 conditions apply Club Membership Fees are $50** p/a Where would you like the vehicle inspected? Other Address If you have any questions regarding registration. Please call Ray on 0488 424 205 I agree with the Club Guidelines / Constitution and Terms And Conditions associated with Kinglake Phoenix Rod & Custom Club you must agree to our guidelines and terms to complete your registration.

Email Address
Your Member #
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