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Owner Information |
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First Name: |
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Last Name: |
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Address 1: |
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Address 2: |
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City: |
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State: |
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Zip Code: |
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Phone Number: |
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Email Address: |
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Vehicle Information |
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Year: |
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Make: |
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Model: |
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Mileage: |
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License Plate#: |
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VIN#: |
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Please Check all that
apply: |
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2-Door
4-Door
Station-Wagon
4-Wheel-Drive |
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Does this vehicle run and
drive as is? |
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Yes
No |
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If not, please explain: |
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Do you have the title? |
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Yes
No |
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If not, please explain: |
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Vehicle Condition: |
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Excellent
Good
Fair
Poor |
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Body Damage: |
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Front End
Rear End
Drivers Side
Passenger Side
Rust
None |
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Problems: |
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Engine
Transmission
Interior
Tires
Other
None |
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If you checked any of the
above problems, please explain: |
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Comments or special
instructions: |
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