 First Name:
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Last Name:
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Address:
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City:
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State Issued:
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Zip:
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(Area Code) Daytime Phone:
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EMail:
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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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Doors
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Trim Level (if known)
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Interior Color
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Exterior Color
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Cylinders
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Liters
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Mileage:
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Vehicle Identification No.:
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Transmission
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Lien Holder
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Estimated Payoff
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Vehicle Options
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AM/FM Radio
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Cassette
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CD
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CD Changer
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Power Windows
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Power Locks
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A/C
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Rear A/C
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ABS
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Cruise Control
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Tilt Control
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Roof Rack
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Sunroof
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Alloy Wheels
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Drive Train
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Tow Package
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Dual Air Bags
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Side Air Bags
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Power Seat(s)
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Leather Seating
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Overall Vehicle Condition
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Rate the condition of the following: 1 being Poor, 10 being Excellent.
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Metal/Paint (Scratches, dings, dents, rust, fading)
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Tires (50% tread wear - replacement)
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Upholstery (Tears, burns, stains)
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Glass (Fractures, spiders, chips)
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Clutch (Clutch slipping)
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Brakes (Squeaky, noisy)
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Collision History
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Has your vehicle ever been involved in a collision?
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If yes, was a Body Shop estimate of repairs written?
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Were Body Shop repairs performed?
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Was the vehicle repaired to your complete satisfaction?
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Exterior Condition
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Are any of the painted surfaces scratched, rusted, or faded?
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Are there any dents and dings?
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Have any of the painted surfaces been repainted or touched up?
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Does any of the glass have fractures, spiders, or chips?
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Interior Condition
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Does the upholstery have tears, burns, or stains?
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Does the stereo system or any of its components need repairs?
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Do all of the gauges and dash functions work?
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Mechanical Condition
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Does the engine need any repairs?
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Does the transmission need any repairs?
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Is the clutch slipping or need any repairs?
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Are the brakes squeaking or in need of repair?
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Has the transmission or engine ever been replaced?
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Questionnaire
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Has the vehicle ever been a taxi, rental car, or police car?
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Has the vehicle ever been in water deeper than the midpoint of the tires?
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Has the vehicle ever been declared a "Flood" vehicle?
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Is the vehicle's frame in need of repair?
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Has your vehicle's frame ever been repaired?
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Has the vehicle ever had a salvage title?
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Is this a "lemon law buyback" vehicle
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Has the vehicle ever been declared a total loss?
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Is the vehicle air bag in working order?
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Has the vehicle air bag ever been deployed?
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Do you have any of the service records for this vehicle?
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Do you have records for any oil change within the last 5000 miles?
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Is the catalytic converter attached and working properly?
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Are the inspection stickers current?
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Has the spare tire ever been used?
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Do any of the tires need to be replaced?
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Is the pollution control equipment attached and working properly?
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Is there anything else we should know about this vehicle?
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