About You:

Last Name:

First Name:

Street:

City:

State:

Zip:

Email:

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Phone:

About Your 69 Trans Am:

Yes No

VIN:

Can your VIN be published?

Miles:

400 cid Ram Air III 400 cid Ram Air IV

Turbo Hydra-matic Automatic 3-speed Manual 4-speed Manaul

Engine:

Transmission:

Coupe Convertible

Standard Interior Deluxe Interior

Interior Color:

Body:

Interior:

Year you Aquired:

Purchased from:

(If known)

Website:

Factory Options (3 digit) as appears on PHS documentation:

Comments:

After submitting this form please Email PHS documentation in order to have your car show in the registry as confirmed.

IMPORTANT: I have received a few emails indicating a possible problem with the transmission of this page. If you do not receive a reply to your form submission within a few days, please email me and I will figure out a way to get the info to me. If you have submitted information recently and no listing appears on the registry, please email me.