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First Name
Last Name
Email
Year
Make
Model
Mileage
Does your vehicle have a lien?
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Yes
No
Clean AZ Title?
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Yes
No
Vehicle Condition:
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Fair-Has major cosmetic defects and requires some mechanical repairs
Good- Has repairable cosmetic defects and mechanical problems
Very Good- Has minor cosmetic defects and is in good mechanical condition
Excellent- Looks new and is in excellent mechanical condition
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