Lease Vehicle Receipt and Disclosure Form ... - Chrysler

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NEW VEHICLE IDENTIFICATION NUMBER

LICENSE NUMBER

TURN IN VEHICLE IDENTIFICATION NUMBER

LICENSE NUMBER

CIDCNIDUUMMBBEERR

Please complete all sections of this form and return to Company Car Operations:

Scan and email to cocars@ or Fax 248-512-0571

For questions, please contact Company Car at 800-481-6736

Mailing address: 4300 S Lapeer Rd, Orion Twp, MI 48359

RPECleEaIPseT OcoFmTHpEleTteURaNll-IsNeVcEtiHoInCsLEoDf EthSiCsRfIoBrEmD aAnBdOVfaExIS HEREBY to CoAmCpKaNnOyWCLaErDOGEpDe.raTtHioEnVsEHaItC2L4E8I-S5I7N6M-8Y29C2U.STODY.

O TurItn-iIsn Vtheheiclleesissgeoein'sg rtoesbepopunrschibaisleitdy to ensure that all

information is correct. Your lease payments cannot be

O Turand-IjnuVsetehdiclewiisthgooiungt ttohbise fcoornmsig. ned to auction:

Dealership Contact Name(printed):_______________________________

DeREaDEleCGrEEsIDhPi.TpTOCHEFonVTtHEacHEtICTPULhERoNnIS-eININNVuMEmYHbCIeCUrL:S_ET_DO_E_DS_YC_. _R_IB_E_D__A_B_O_V_E__IS__H_E_R_E__B_Y_A_C_K_NOWL-

RECEIVING DEALERSHIP NAME

DEALERSHIP TELEPHONE NO. (INCLUDE AREA CODE)

DEALER ADDRESS

CITY

STATE

DEALERSHIP SIGNATURE

DEALER CODE

REPAIRSRREEPQAUIRIRSERDEOQNURIREEPDLAOCNETDUORRN-RINEVTUEHRINCELDE VEHICLE

DESCRIPTION OF DAMAGE

REPAIR COST ESTIMATE

EXTERIOR

$

INTERIOR

SERVICE AND REPAIR COST GRAND TOTAL $

DDISISCCLLOOSSUURREE SSTTAATTEEMMEENNTT

NNOOTTEE A:AF:EDFEERDAELRLAALW LAW REQREUQIRUEIRSESTHTAHTATTTHHEELLEESSSSEEEE DISCDILSOCSLEOSTEHTEHEMMIILLEEAAGGEE TTOOTHTEHE LESSSSOORRININCOCNONNENCETCIOTNIOWNITHWITH THEE TTRRAANNSSFFEERROOFFOOWWNENRESRHSIHP.IP.

FFAAIILLUURREETOTCOOMCPLOEMTPELOERTE OR MMAAKKIINNGGA AFALFSAELSSETATSETMAETNETMENT MMAAYY RREESSUULTLTINIFNINFEISNEASNDA/ONRD/OR IMPPRRIISSOONNMMEENNTT. .

CURRENT ODOMETER READING:

CURRENT ODOMETER READING:

Has turn-in vehicle been repaired due to a collision?

Yes

No

TO THE BEST OF MY

VVeehhiciclelesswwitihthddamamagaegseasmaomuontuinngtintog $t5o0$01.0,000o0r omromreomreumstubset rbeepareirpedairinedacincordaacnccoerdwaitnhctehewaicthcidtheenta&ccviedheicnlteadnadmavgeehricepleordtianmg apgoelicrye.porting policy.

KNOWLEDGE, THE ODOMETER

TROEATDHINEGB: (ECSHTECOKF OMNYE)KNOWLEoDGREF, LTEHCETSOTDHOEMAECTTEURARL EADINGM: I(LCEHAEGCEKOONNTEH) E VEHICLE.

LESSEE NAME

o IS NOT THE ACTUAL RMEILFELAEGCETSON TTHHEEVEHAICCTLUEAL MANILDEASGHEOUOLNDTNHOETVBEEHICLE.

HOME ADDRESS CITY / STATE / ZIP CIMS CODE

IIaauuththoorirzizeededdeudcutciotinosnsfrofrmommymsyalsaarylaoryr poernpsieonnspioanympaeynmt, eonr ta, noyr oathneyr other aammoouunnttssdduueeFCChAryUsSlerLLLCLCfrofrmommme,ef,orfoarnayncyhacrhgaersgefosrfvoerhicle abuse

(vinechluicdleingablaucskeof(imncaluindtiennganlaccek), okef ymreapinlatecneamnecnet), uknepyairdepalarckeinmgefninte, su,nopraid

epxacreksinsglofainneesr,voerhiecxleceusssagloea, naenrd vaenhyicoletheurscahgaer,gaensdfoarnthyisovtheehricclehaarsgseesssfoerd

inthaisccvoerhdiacnleceawssitehstsheedCoinmpaaccnoyrCdaanrcPerowgritahmsthTeerCmosm, pCaonnyditCioanrs Panrodgrams

ITsncsertrirmbuecsdt,iohCnesor.neRdinieticoisenisphte/aDrenebdliyvIenarscytkronufocttwhioelenvdseg. heRidceleac(nesdi)pdtt/ehDseeclriDvibeisercydlohoseufrreethineSistavheteehmriceelbenyt

deon

athckenroigwhlteidsgceodmapnldetteheanDdisccolorrseucrte. Statement on the right is complete and

accurate.

LESSEE/DESIGNATED SIGNATURE

DATE VEHICLE DELIVERED/TURN-IN

IRSELNIEODT UTPHOEN.A(CPRTUOACLEDMUIRLEE-

AINGNEOOTEN BTMHEUSVTEBHEICLE AND

SFHOOLLUOLWD ENDO.)T BE RELIED UP-

o

ON. (PROCEDURE IN NOTE MREUFSLTEBCETSFOMLILLOEAWGEED.)

B

ACCUMULATED AFTER

ROEDFOLMEECTESR M"TILUERANGEED- ACCUMOUVELART".ED AFTER ODOMETER "TURNED-OVER". HAS THE ODOMETER BEEN

HSAESRVOICDEODM, ERTEEPRAIRBEEDNORSERVRIECPELDA,CERDE?PAIRED OR REPLACED?

NO

YES

NOTE B: EACH TIME ODOMETER IS NISSEORTSVEEIRCBEV:DIC,EERADEC,PHARIRETIEPMDAEIOROREDDOOMRETREERPRLEAPCLAECDEADNADNDITITDODOESESNNOOTTREGISTREERGISTTHEER STHAEMESAMMIELEMAILGEEAGAESASBE-

FBOEFROERETHTEHESSEERRVVIICCEE,, RREEPPAAIRIROROR

REMOOVVAALL,,TTHHEEOODODOMMETEETREMRUMSUTST

BE AADDJJUUSSTTEEDDTTOORREAEDADZEZREOR.OA.LASLO-,

SIFOIT, IFS AITDJIUSSATEDDJUTSOTREEDADTOZEREOA, AD

ZNEORTOIC,EAINNDOICTAICTIENGINTDHICEAMTILINEGAGTEHE

MBEILFEOARGEEANBDEFTOHREEDAATNEDOTFHTEHEDATE

OADFJUTSHTEMEANDTJUMSUTSMT EBNETAFMFIUXSEDT TBOE

AFTRHFFEAIMXLEEEFDT

D(TUOOSOERTFHRMEAOMPELAE(URFSTE

DOOR LABEL

#M3O5P9A27R5L0A.)BEL #3592750).

UPON COMPLETION SEND TO Company Car Operations (AT ABOVE ADDRESS)

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