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© Gesica – Bloody Mary 2015
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Contact Information
First Name
Work Phone
Email
Last Name
Phone
Preferred Contact
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Phone
Comments
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Vehicle Information
Year
Model
VIN
Engine
Transmission
Automatic
Manual
Make
Exterior Colour
Kilometres
Doors
2
3
4
5
Drivetrain
2WD
4WD
AWD
Vehicle Rating
Body (dents, dings, rust, rot, damage)
10 - best
9
8
7
6
5
4
3
2
1 - worst
Engine (running condition, burns oil, knocking)
10 - best
9
8
7
6
5
4
3
2
1 - worst
Glass (chips, scratches, cracks, pitted)
10 - best
9
8
7
6
5
4
3
2
1 - worst
Exhaust (rusted, leaking, noisy)
10 - best
9
8
7
6
5
4
3
2
1 - worst
Tires (tread wear, mismatched)
10 - best
9
8
7
6
5
4
3
2
1 - worst
Transmission / Clutch (slipping, hard shift, grinds)
10 - best
9
8
7
6
5
4
3
2
1 - worst
Interior (rips, tears, burns, faded/worn, stains)
10 - best
9
8
7
6
5
4
3
2
1 - worst
Vehicle History
Was it ever a lease or rental return?
Yes
No
Is the odometer operational and accurate?
Yes
No
Detailed service records available?
Yes
No
Title History
Is there a lienholder?
Who holds this title?
Vehicle Assessment
Does all equipment and accessories work correctly?
Did you buy the vehicle new?
Has the vehicle ever been in any accidents? Cost of repairs?
Is there existing damage on the vehicle? Where?
Has the vehicle ever had paint work performed?
Is the title designated 'Salvage' or 'Reconstructed'? Any other?
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