LONG-LEWIS^TM OFFER TO PURCHASE

Sales Person:

Today's date:

First Name:

Last Name:

Street Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Email:

VEHICLE INFORMATION

Year:

Make:

Model:

Trim:

VIN:

Miles:

Exterior Color:

Interior Color:

Engine Size (Liters):

FWD, 4WD, AWD, ETC:

TRUCK CAB: REG, SUPER, CREW, ETC

CAR STYLE: 2DR, 4DR, WAGON, ETC

Extra Key Set:

Yes

TRANSMISION TYPE: AUTOMATIC, MANUAL

WHEEL SIZE (INCHES):

WHEEL TYPE: STEEL, ALLOY, CHROME, ETC

Please rate the following to the best of your abilities(1 = NOT GOOD, 10 = LIKE NEW)

Does this vehicle have a branded, rebuilt, or salvage title?Yes No If yes, please explain

Does this vehicle have any current mechanical issue?Yes No If yes, please explain

Has this vehicle been involved in an accident or had paint work?Yes No If yes, please explain

Has this vehicle had any major repairs?Yes No If yes, what?

Will any equipment be removed or altered?Yes No If so, what?

Is this the actual milage?Yes No

How many miles on your tires?

How often do you have the oil changed?

When did you change last?

Did you buy this car new?Yes No

Amount of your monthly investment?

May a prospective buyer call you?Yes No

Would you recommend this vehicle to a friend or co-worker?Yes No

Does your vehicle have a balance on extended service warranty? Yes No

Manager's Comment: