Customer Name: 

Vehicle Year: 

Vehicle Make: 

Vehicle Model:

Vehicle Serial Number:

Odometer:

Engine Make:

Engine Horsepower:

Fuel Type GasDiesel

Transmission Make:

Transmission Speeds:

Transmission Type AutomaticManual

Gross Vehicle Weight Rating (GVWR):

Rear Axle Ratio:

Vehicle Color:

Front Axle Weight:

Rear Axle Weight:

Front Brakes 25%50%75%New

Rear Brakes 25%50%75%New

Driveline Tires 25%50%75%New

Rear Tires 25%50%75%New

Air Slide 5th Wheel? YesNo

Air Conditioning? YesNo

Wheelbase:

Engine Brake? YesNo

Aluminum Wheels? YesNo

Power Steering? YesNo

Air Ride? YesNo

Day Cab? YesNo

Wet Line Kit? YesNo

Sleeper? YesNo

Vehicle Retail Price:

Vehicle Wholesale Price:

Has Vehicle Been Reconditioned? YesNo

If Yes, Please List All Reconditioning Performed And Date Of Item

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I CERTIFY THE ABOVE INFORMATION IS TRUE AND ACCURATE REPRESENTATION OF THE ABOVE NAME EQUIPMENT.