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Comments:
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VEHICLE INFORMATION: Year: Make: Model: Miles: VIN:
Doors: pick one 2 3 4
Transmission: Automatic Manual
Engine: 3 cyl 4 cyl 6 cyl 8 cyl
Air Conditioning: Yes No
Power Windows: Yes No
Interior: Cloth Leather
4-Wheel Drive: Yes No
Trimline:
VIN Number:
Salvage Title: Yes No
Does your vehicle have remainingManufacturer Warranty? Yes No
Does your vehicle have remainingExtended Warranty Yes No
Do you have an outstanding balance? Yes No If so...Bank Name? If so...What is estimated payoff?
Brief Description of Vehicle:
Poor
Average
Good
Excellent
List Additional Options: Tell us any additional features like running boards, bed liner, etc...
Recent Repairs and Maintenance: Tell us about new tires, exhaust, brakes, tune-ups, etc...
CUSTOMER INFORMATION:
*Name: Address: City: State: Zip: *E-mail: *Phone: Work Phone: FAX:
Are you considering: New Vehicle Used Vehicle
What is the maximum monthly payment you would like?: less than $100 less than $200 less than $300 less than $400 less than $500 less than $600 less than $700
Note: Appraisal subject to accurate representation and physical inspection of vehicle.