Client Vehicle Purchase Intake Form

NEW CLIENT INTAKE FORM
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address*
example@example.com
Telephone Number*
Please enter a valid phone number.
Are you trading in a vehicle?*

YesNo
Trade-In Vehicle VIN
Trade-In Vehicle Mileage
Is there any damage to the trade-in vehicle?

YesNo
Is the trade-in vehicle leased or owned?

LeasedOwned
Trade-In Vehicle Bank Name
Amount Owed on Trade-In Vehicle
Details of the New or Used Vehicle Desired (Please include makes and models of interest)*
Maximum Down Payment
Monthly Budget
Do you want to lease or finance the new vehicle?

LeaseFinance
Credit Options

Great 740 or betterAverage 640 or betterBelow avg credit challenge under 640
Are you Active Duty Military or retired Military?

YesNo
Are you a first responder (Police, Fire, EMS)?

YesNo
Should be Empty:

NEW CLIENT INTAKE FORM