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Contact Information
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Vehicle Information
Year:
Make:
Model
Interior Color:
Exterior Color:
Mileage:
Vehicle Identification No.:
Lien Holder
Estimated Payoff
Overall Vehicle Condition
Overall Vehicle Condition
Rate the condition of the following: 1 being Poor, 10 being Excellent.
Metal/Paint (Scratches, dings, dents, rust, fading)
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1
2
3
4
5
6
7
8
9
10
Tires (50% tread wear - replacement)
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1
2
3
4
5
6
7
8
9
10
Upholstery (Tears, burns, stains)
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1
2
3
4
5
6
7
8
9
10
Glass (Fractures, spiders, chips)
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1
2
3
4
5
6
7
8
9
10
Brakes (Squeaky, noisy)
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1
2
3
4
5
6
7
8
9
10
Collision History
Has your vehicle ever been involved in a collision?
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yes
no
Were Body Shop repairs performed?
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n/a
yes
no
Exterior Condition
Are there any dents and dings?
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yes
no
Does any of the glass have fractures, spiders, or chips?
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yes
no
Interior Condition
Does the upholstery have tears, burns, or stains?
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yes
no
Is there any pet or smoke odor?
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Yes
No
Do all of the gauges and dash functions work?
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yes
no
Mechanical Condition
Does the engine need any repairs?
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yes
no
Are the brakes squeaking or in need of repair?
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yes
no
Questionnaire
Has the vehicle ever been a taxi, rental car, or police car?
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yes
no
Has the vehicle ever been declared a "Flood" vehicle?
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yes
no
Has the vehicle ever had a salvage title?
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yes
no
Is the vehicle air bag in working order?
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yes
no
Has the vehicle air bag ever been deployed?
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yes
no
Do you have any of the service records for this vehicle?
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yes
no
Is the catalytic converter attached and working properly?
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yes
no
Do any of the tires need to be replaced?
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yes
no
Is there anything else we should know about this vehicle?