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Contact Information
Name
*
Email
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Phone
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Vehicle Information
Year
*
Make
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Model
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Trim
Mileage (in KM)
*
Body Style
Transmission
*
Automatic
Manuel/Standard
Other
Drive Train
Front Wheel Drive
Rear Wheel Drive
All Wheel Drive
Fuel Type
Gas
Diesel
Hybrid/Electric
Other
Condition
*
Excellent
Good
Fair
Poor
VIN
Color
Vehicle Condition
Body
10 - Excellent
9
8
7
6
5 - Moderate
4
3
2
1 - Poor
Tires
10 - Excellent
9
8
7
6
5 - Moderate
4
3
2
1 - Poor
Transmission
10 - Excellent
9
8
7
6
5 - Moderate
4
3
2
1 - Poor
Interior
10 - Excellent
9
8
7
6
5 - Moderate
4
3
2
1 - Poor
Glass
10 - Excellent
9
8
7
6
5 - Moderate
4
3
2
1 - Poor
Options
Power Windows
Power Seat(s)
Air Conditioning
Alloy Wheels
Cruise Control
Power Door Locks
AM/FM Radio
CD Changer
DVD/Entertainment
Sunroof
Leather Seats
Has your vehicle been involved in any accidents or had any insurance claims against it?
No
Yes
If you have checked Yes please enter the amount of insurance claim
Has your vehicle been registered in USA?
No
Yes
If yes which State?
Has your vehicle been registered in another province?
No
Yes
If yes which province?
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