First Name
Surname
Email
Phone
Car VIN Number
Car Make
Car Model
Year
Current Mileage
How would you rate the condition of your car? No RatingExcellentGoodFairPoor
Has the car been involved in any accidents? YesNo If yes, please provide details.
Are there any mechanical issues with the car? YesNo If yes, please provide details.
Are there any cosmetic damages (e.g., dents, scratches, paint issues)? YesNo If yes, please provide details.
Do you have title for the car? YesNo
Is there any loan or lien on the car? YesNo
Are there multiple owners listed on the title? YesNo
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