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Your Name: 

E-mail Address: 

Phone Number:

Year, Make, Model:

License Plate #:

Trim Level (ie. LX, Sle, C40 etc...):

Trucks = 2wd  4wd  single cab extra cab
        crew cab  buckets  bench

Miles:  Engine = 8cyl  6cyl  4cyl  diesel

Ext. Color: Int. Color:

Ext. Condition = excel  very good  good  fair

Int. Condition = excel  very good  good  fair

Leather interior   Cloth interior

Air condition = cold  broken  dual  none

Power Seat(s) = driver's  both  none

Doors = 2Dr.  3Dr.  4Dr.  other

Transmission = automatic  manual  other

Radio = am/fm  cassette  single-cd  multi-cd   8-track  none

Tires = very good  good  fair  poor

Wheels = alloy  chrome  covers  none

Extras = power windows  power locks  entertainment center None DVD/TV VCR/TV
             sunroof  moon roof  t-tops  navigation system
             tilt  cruise  side airbags

Windshield = no damage  chipped  cracked

Hail damage = none  repaired  not repaired

Number of Keys =   Number of Remotes =

Additional Equipment not Listed Above

List damage - repaired

List damage - not repaired

Describe areas that have been painted

Total cost of repairs =

I attest that the information I have given here is,
to the best of my knowledge, accurate.
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Date