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1.
First Name
2.
Last Name
3.
Middle Initial
4.
Title
5.
Street Address
6.
City
7.
State
8.
Zip
9.
Work Phone
10.
Home Phone
11.
Today's date :
12.
Enter your name as it appears on your credit card.
13.
Enter your credit card expiration date.
14.
Enter your credit card number in the space provided below.
15.
Please provide the Year
16.
Make,
17.
Model
18.
VIN#
19.
Enter the general condition of your classic.
20.
License Number & State
21.
Enter Size and Number of Dents, Dings, and Scratches
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22.
Condition of Air Conditioning
23.
Radio/Stereo Make & Type
24.
Enter Odometer Reading
25.
Exterior Paint Color & Condition 26.
Rust Location & Amount
27.
Enter Tire Size, Brand, & Tread wear
28.
Enter Wheel Type & Make
29.
Enter Dashboard Condition
30.
Enter Interior Door Panel Condition
31.
Enter Seat Condition & Quality
32.
Enter Door Panel condition
33.
Enter Headliner Condition
34.
Enter Motor Size and Condition
35.
Enter Transmission Condition
36.
Enter Suspension Condition
37.
If your classic is a Convertible does it have both Hard and Soft
Tops?
38.
Enter condition of Tops
39.
Enter condition of Shocks
40.
Enter condition of Steering
41.
Enter condition of Brakes
42.
Enter Heater condition |