Service Application Form

Customer Information

Company:

(for company owned vehicles only)

First Name:

Last Name:

Day Phone:

Evening Phone:

Email:

(we do not give out your email to any other party.)

Mailing Address

Address:

Apt/Unit/Suite:

City:

State:

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Zip:

Title Information

State Issued:

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Clear (no lien):

Yes No   (we cannot sell your car if there is still a lien against it)

Have Lien Release:

Yes No   (please check front of title, if the original lienholder is still on title we will need a lien release letter)

Vehicle Information:

Type:

Select One Car Motorcycle Boat RV Other

VIN (vehicle id):

Year:

Make:  (Toyota)

Model:  (Camry)

Mileage:

Four-Wheel Drive:

Yes No

Color:

Currently Registered:

Yes No

Registration State:

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Vehicle Pickup Address:

Same as Mailing Address Pickup Not Required

Vehicle Address:

Vehicle City:

Vehicle State:

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Vehicle Zip:

Vehicle Condition:

Battery Dead:

Yes No

Starts Reliably:

Yes No

Transmission Works:

Yes No

Engine Works:

Yes No

Safe to Drive:

Yes No

Collision Damage:

Select One None Minor Major

Body Rust:

Select One None Minor Major

Paint:

Select One Poor Fair Good Excellent

Interior:

Select One Poor Fair Good Excellent

Stereo:

Select One Stock Custom None

Condition Comments:

Tow/Delivery Information:

Tow Required:

Yes No

At Repair Shop:

Yes No

Towing Comments:

Additional Information:

How you Found Us:

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Additional Comments: