Richard West & Associates Vehicle Information Checklist ©

Name(s) on the Title:

Body Style

□ 2 Door Coupe

□ 4 Door Sedan

□ Pickup Truck

□ SUV

□ Crossover

□ Van

□ Convertible

□ Hybrid

□ Limousine

□ Motorcycle

□ Motor Home

Status:             □ Own     □ Purchase     □ Leasing

Date of Purchase:                    /          /

Comments:

 

 

 

 

What could you sell this vehicle for in its current “as is” condition, without fixing anything at all on it?  $______________________________

 

Description of Vehicle - Please indicate the Make, Model and year of vehicle below  

 

 

 

 

 

Parts in Need of Repair – Mark all that apply

□ Fuel Injector/Pump

□ Power Steering

□ Oil Leaks

□ Pistons

□ Alternator

□ Electrical

□ Instrument Panel

□ Battery

□ Starter

□ Transmission

□ Clutch

□ Fans

□ Belts/Hoses

□ Radiator

□ Cooling System

□ Water Pump

□ Heater

□ Shocks/Struts

□ Brakes/Rotors

□ Tires

□ Suspension

□ Alignment

□ Windshield/Windows

□ Locks

□ Front/Rear Seats

□ Seat Belts

□ Air Bag(s)

□ Carpet

□ Door Handles

□ Headlights

□ Brake Lights

□ Front Body Damage

□ Rear Body Damage

□ Side Body Damage

□ Other

 

Lender Information

Leasor Information

Lender’s Name:

Leasor’s Name:

Monthly Payment:  $

Monthly Payment:  $

Number of Missed Payments:

Number of Missed Payments:

Balance Owed:  $

Start Date:     /     /          End Date:     /     /

If applicable, Date of Repossession:     /     /         

If applicable, Date of Repossession:     /     /