Grant Redemption Form
Dealership Name
*
Dealer Email
*
Dealership Representative
*
First Name
Last Name
Participant Name
*
First Name
Last Name
DCAP Approval Number
*
Purchase or Lease Date
*
Purchase Type
*
Please Select
Purchase
Lease
Vehicle Type
*
Please Select
New
Used
Financing Type
Please Select
Pre-approval/DCAP Financing
Financed With Dealership
Cash Payment
Gross Capitalized Cost
*
Cash Price of Motor Vehicles and Accessories
*
Used Vehicle Required Documents
*
History Report (attach below)
Inspection Report (attach below)
Purchase Contract (attach below)
Grant Redemption Checklist (attach below)
New Vehicle Required Documents
*
Purchase Contract (attach below)
Grant Redemption Checklist (attach below)
Purchase Contract
*
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of
Lease Agreement
*
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of
Grant Redemption Checklist
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History Report
*
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Inspection Report
*
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Submit
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