VEHICLE OR TITLED PROPERTY BILL OF SALE

Application - Page 1 of 2

Date of Sale: *

Seller Name:

Seller Address:

Buyer Name:

Buyer Address:

Type of Vehicle / Property: *

Make: *

Model: *

Year: *

Body Style (if applicable):

Color: *

VIN / Hull Id / Other Id: *

Odometer / Engine Hours: *

License Plate (if any):

Purchase Price: *

Paid By: *

Cash

Certified Check

Wire Transfer

Other

Disclosure and Odometer Statement: *

As the Seller, I certify that to the best of my knowledge, the odometer reading (or engine hours) is accurate.

As the Seller, I certify that the odometer reading (or engine hours) reading is not the actual mileage (odometer/hour discrepancy).

The odometer has exceeded its mechanical limits.

Odometer Reading (miles / hours): *

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