Inscripciones 2

NOMBRE(S):*
APELLIDO(S):*
CÉDULA DE IDENTIDAD:*
CORREO ELECTRÓNICO:*
TELÉFONO:*

ESTADO:*
ESTUDIANTE CARRERA:*
UNIVERSIDAD/ACADEMIA/INSTITUTO:*
SEMESTRE/COHORTE/AÑO:*
CARNET/ CONSTANCIA DE ESTUDIO O INSCRIPCION:*

DATOS DEL PAGO

MODALIDAD:*
FECHA DE PAGO:*

NÚMERO DE CÉDULA DEL TITULAR DE LA CUENTA DONDE REALIZÓ LA TRANSFERENCIA:*

OBSERVACION: En este item debes colocar el número de cédula del titular de la cuenta de donde se realiza la transferencia.

BANCO EMISOR:*

MONEDA:*
MONTO TRANSFERIDO:*

Nota: Utiliza el punto como separador decimal

IMAGEN DE LA TRANSFERENCIA:*

NOMBRE DEL EVENTO:*

En caso de pagos en Bs. se debe utilizar la tasa BCV del dia como referencia.

Sitio web desarrollado por el Ing. Marco Gómez (Marcoweb)

Trade-In

Contact Information

First Name

Work Phone

Email

Last Name

Phone

Preferred Contact
Email Phone

Comments

Options

Vehicle Information

Year

Model

VIN

Engine

Transmission

Make

Exterior Colour

Kilometres

Doors

Drivetrain

Vehicle Rating

Body (dents, dings, rust, rot, damage)

Engine (running condition, burns oil, knocking)

Glass (chips, scratches, cracks, pitted)

Exhaust (rusted, leaking, noisy)

Tires (tread wear, mismatched)

Transmission / Clutch (slipping, hard shift, grinds)

Interior (rips, tears, burns, faded/worn, stains)

Vehicle History

Was it ever a lease or rental return?

Is the odometer operational and accurate?

Detailed service records available?

Title History

Is there a lienholder?

Who holds this title?

Vehicle Assessment

Does all equipment and accessories work correctly?

Did you buy the vehicle new?

Has the vehicle ever been in any accidents? Cost of repairs?

Is there existing damage on the vehicle? Where?

Has the vehicle ever had paint work performed?

Is the title designated 'Salvage' or 'Reconstructed'? Any other?

Name:
Email:
Friends Email:
Message:

Name:
Preferred Contact:	Email Phone
Email:
Phone:
Offered Price:
Financing Required:
Other Comments/Conditions:

Name:
Preferred Contact:	Email Phone
Email:
Phone:
Best Day:
Best Time:

Name:
Preferred Contact:	Email Phone
Email:
Phone:
Questions/Comments:

Inscripciones 2

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