Application For Vehicle Log Book Page 2
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1
2Owner Details
Owner
Partner/ Co-Owner
Name
Name
Postal Address
Postal Address
State / Postcode
State / Postcode
Phone
Phone
IHRA Member #
IHRA Member #
I/We the undersigned hereby state that the details shown above, and on the front of the form are true, and I/we undertake to
observe all the requirements of the track & IHRA regulations pertaining to the issue of the Logbook for the vehicle described.
I/we declare that the vehicle as described above is owned by me and/or the parties stated above.
Signed (owner)
Signed (Co-Owner)
Date
Date
Vehicle Log Book $50.00 (inc GST)
Junior $25.00 (inc GST)
Enclosed $
by C
Cheque / Money Order / Direct Deposit (EFT) / Credit card details
Credit Card Details
** please note all credit card transactions will incur an additional $2 (inc GST) surcharge **
Mastercard
Visa
Expiry Date
/
Signature of Cardholder
Office use only
New/Renewal
Lic. No
Tech #
Lic. No
Date
Roll Cage Tag No (New App)
Page 2
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