Empire Motor Group Trade-In Form
Date
-
Month
-
Day
Year
Today's Date
How did you hear about us?
*
Please Select
Google
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Other Social Media
Other
Applicant Information
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Car Trade-In Information
Put NA if the field in not applicable to your car
Are you the original owner of the car?
*
Yes
No
Do you have a California Registration?
*
Yes
No
Is the title paid off?
*
Yes
No
VIN#
*
Pay Off Amount
*
Year
*
Make
*
Model
*
Miles
*
Engine Condition
*
Transmission Condition
*
Dash Lights Condition
*
How many miles are on your tires?
*
Windshield condition?
*
Cracked
Pitted
Starred
Okay
Any accidents?
*
Yes
No
List any body damages
*
List any car repaints
*
Rate the condition of the car
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Rate the condition of the paint
*
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
What is your asking price
*
Round to the nearest dollar
Additional notes
*
Submit
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