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Personal Information
Name:*
First Last
Email:*
Phone:
Birthdate:*
Month
Day
Year
Drivers License #:*
Social Security #:*
Residence Information
Occupancy Type:*
Mortgage/Rent $ Amount:*
Current Address:*
Street Address City State ZIP
Years at Current Address:*

Please enter a number from 1 to 99.
Employment Information
Current Employer:*
Employer Phone #:*
Employer Address:*
Street Address City State ZIP
Occupation/Title:*
Time with Employer:*

Please enter a number from 1 to 99 and indicate months and years.
Total Monthly Income (Gross):*
Untitled*
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Contact Information

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Work Phone

Email

Last Name

Phone

Preferred Contact
Email Phone

Comments

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Vehicle Information

Year

Model

VIN

Engine

Transmission

Make

Exterior Colour

Kilometres

Doors

Drivetrain

Vehicle Rating

Body (dents, dings, rust, rot, damage)

Engine (running condition, burns oil, knocking)

Glass (chips, scratches, cracks, pitted)

Exhaust (rusted, leaking, noisy)

Tires (tread wear, mismatched)

Transmission / Clutch (slipping, hard shift, grinds)

Interior (rips, tears, burns, faded/worn, stains)

Vehicle History

Was it ever a lease or rental return?

Is the odometer operational and accurate?

Detailed service records available?

Title History

Is there a lienholder?

Who holds this title?

Vehicle Assessment

Does all equipment and accessories work correctly?

Did you buy the vehicle new?

Has the vehicle ever been in any accidents? Cost of repairs?

Is there existing damage on the vehicle? Where?

Has the vehicle ever had paint work performed?

Is the title designated 'Salvage' or 'Reconstructed'? Any other?

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Vehicle Information

Vehicle Rating

Vehicle History

Title History

Vehicle Assessment

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Phone:
Offered Price:
Financing Required:
Other Comments/Conditions:

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Vehicle Information

Vehicle Rating

Vehicle History

Title History

Vehicle Assessment

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