Statement Of Intent To Sell

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Statement of Intent to Sell
Date: ________________________________
I, _______________________________, do hereby intend to sell my _______________________________
(Seller)
(Make of Vehicle)
To ____________________________________ for the sum of $ ___________________________________
(Buyer)
Down Payment (if any) $ ______________________________
Seller Initial ____________
Vehicle Information:
Year
Body
No. Cyl.
Color
Odometer Reading
Serial Number
Please list options in vehicle on the back of this form
1. The seller MUST provide the following on the said vehicle
a. A copy of the most recent REGISTRATION CARD
b. A copy of the TITLE (Front and Back)
2. I, the seller hereby certify that the said vehicle is:
________ Lien Free (Please initial)
________ Current Lien: (Please initial)
Name of Lien holder: _____________________________________________________________________
Lien holder address: _____________________________________________________________________
_____________________________________________________________________
Lien holder telephone number: ____________________________________________________________
Net payoff amount good for 30 days $_________________
(attach written verification from lien holder)
Seller(s) Signature: _______________________________________________________________________
Sellers address: __________________________________________________________________________
__________________________________________________________________________
Sellers telephone number: _________________________________________________________________

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