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Contact Information
(Area Code) Work Phone:
Please select a time that is convenient for you.
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Anytime
Morning
Mid-day
Afternoon
Evening
Comments or Questions
Vehicle Options
Air Conditioning
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Yes
No
Navigation System
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Yes
No
CD Changer
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No
In Dash
External
Power Windows
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Yes
No
Sunroof
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No
Sliding
Pop-up
AM/FM Radio
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Yes
No
Power Locks
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Yes
No
DVD Player
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Yes
No
Cassette
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Yes
No
Power Seat(s)
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No
Driver
Pass
Both
Satellite Radio
choose one:
Yes
No
Leather Seating
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Yes
No
Cruise Control
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Yes
No
CD
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Yes
No
Alloy Wheels
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Yes
No
Spoiler
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Yes
No
Vehicle Information
Year:
Mileage:
Exterior Color
Make:
Engine
Doors
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2 Door
4 Door
Hatchback
Model
Transmission
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Automatic
Manual
Drive Train
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4WD
AWD
FWD
RWD
Vehicle Identification No.:
Overall Vehicle Rating
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
Exhaust (rusted, leaking, noisy)
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1
2
3
4
5
6
7
8
9
10
Transmission / Clutch (slipping, hard shift, grinds)
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1
2
3
4
5
6
7
8
9
10
Engine (running condition, burns oil, knocking)
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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)
choose one:
1
2
3
4
5
6
7
8
9
10
Vehicle History
Was it ever a lease or rental return?
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Yes
No
Is the odometer operational and accurate?
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Yes
No
Detailed service records available?
choose one:
Yes
No
Title History
Are there any lienholders and where are they located?
Who holds this title?
Vehicle Assessment
Do all options 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?
