Printable Application

Application for membership to 'Windscreen Angel'.

Please print off and complete fully,include your payment cheque or postal order payable to Windscreen Angel

and post to: Windscreen Angel,228 Spearing Rd,High Wycombe,Bucks HP12 3LA

NameMr,Mrs,Ms ...................................................................................................................................

Address..................................................................................................................................................

..............................................................................................................................................................

Telephone...............................................................................................................................................

Vehicle Make..........................................................................................................................................

Model.....................................................................................................................................................

Colour....................................................................................................................................................

Reg No..................................................................................................................................................

Vehicle Make .........................................................................................................................................

Model....................................................................................................................................................

Colour...................................................................................................................................................

Reg No..................................................................................................................................................

Vehicle Make .........................................................................................................................................

Model....................................................................................................................................................

Colour....................................................................................................................................................

Reg No..................................................................................................................................................

I/We agree that the vehicle details given above are correct and that all vehicle glass is in servicable condition at the time ofthis application being made.I/We can confirm that the front windscreen is NOT of a heated type nor is the windscreen connected in anyway to an airbag circuit

Print Name..............................Sign........................................Date................................................................

Print Name..............................Sign........................................Date................................................................

Print Name..............................Sign........................................Date................................................................