QUOTE REQUEST VEHICLE INFORMATION SHEET
Email to [email protected] to 561-745-1811
DEALER
TITLE CLERk (CONTACT)
VEHICLE INFO
TITLE/TAg/REgISTRATION DEAL INFO
Name
NameTitleEmailPhoneFax
Current DateDEAL TYPEDealer Deal IDReg. StateReg. CountyPlate Type Specialty Plate?Plate NumberRenew Transfer Plate?
VIN
MileageMSRPBody Type YearMakeModelColorShip/Empty Wt.GVWRFuel Type
New (MSO/CO) Used
Address
SALE INFOPurchase DatePurchase PriceDoc Fee
Trade-In ValueRebate
Name
Address
FEID Sales Tax Exempt #
LIEN HOLDERIs there a Lien?
Address
ELT#
Name
Name
Address
SSNSSNDOBDOB DL #DL #
DL StateDL State
Military?Military?
Address
MAILINg ADDRESS VEHICLE (PHySICAL) ADDRESS
Name
Address
FEID Sales Tax Exempt # FEID Sales Tax Exempt #
Address
658 W Indiantown Rd., Suite 201 * Jupiter, FL 33458 | Phone 561-746-5245 | Fax 561-745-1811(QR-VIS Rev-01 10/31)
Jupiter Tag & Title Service
SignatureDate
SUBMITTINg FOR QUOTE: Please complete ALL relevant information on this sheet. Request for quote MUST be signed by submitter. Quotes will incur a $25.00 charge if deal not submitted.
STANDARD CHECkLIST ☐ MSO or Title Properly Reassigned and Notarized (Reassignment & Odometer Sections). ☐ Copy of Driver License. ☐ Original Odometer Statement with Hand Printed Seller & Buyers Names. ☐ Buyers Order or Purchase Order (Certified True Copy of Original). ☐ Copy of Insurance Card Showing Newly Purchased Vehicle. ☐ LEASE: Copy of Lease Agreement (Certified True Copy of Original). ☐ Sales Tax Check or Affidavit of Exemption. ☐ Power Of Attorney Signed & Notarized {LEAVE APPOINTEE BLANK). ☐ FLORIDA DEALERS: DR123 Signed & Notarized.
