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VEHICLE PURCHASE/LEASE ORDER

* required

Congratulations on your decision to purchase/lease a vehicle using Vehicle Assistant. Submit this form only if you are ready to make a purchase/lease using VehicleAssistant. Please complete the information on this order form. After your order has been processed, your personal Vehicle Advisor will contact you as soon as possible to assist you.

* First Name:

* Last Name:

* City:

* State:

* Zip/Postal Code:

* Company Affiliation:
(Your Company, Association or Organization Name)

* Company Access or
Partner Code:

* Daytime Phone Number:

Your Email Address:

Best time to call:

VEHICLE INFORMATION
Please tell us about the vehicle you are purchasing.
Be sure to ask about the savings on our factory warranty, low mileage 2006 vehicles.

Is this Vehicle:
New Used

Year:

Make:

Model:

Options or special features:

MSRP / Sticker Price:
(if available-not mandatory)
$

DEALER INFORMATION

To help us facilitate your purchase or lease, please provide the Dealer information below (if available) for the vehicle you are purchasing or leasing. We will refer you to the closest Select Dealer in your area.

Name of Dealer 1

City:

State:

Phone Number

Name of Dealer 2

City:

State:

Phone Number

TRADE-IN VEHICLE INFORMATION

Please complete the information below if it applies to your purchase or lease.

Year

Make

Model

Mileage

OTHER INFORMATION

Would you like information on our tax deductible vehicle donation program?
Yes No

* How soon do you anticipate purchasing/taking delivery?
Please Click the arrow and choose:

Please give me information on:
      Setting up a test drive
      Financing
      Leasing
      Extended Warranty
      Gap Insurance

* How did you find out about the VehicleAssistant Program: (check all that apply)
      Newsletter/Flyer
      HR Person
      Magazine
      Member/Co worker
      Fleet Administrator
      Other-explain

* This vehicle will mainly be used for:
Family
Business

Other Comments/Questions

Please click the "submit" button when you are ready to send your vehicle purchase information to a Vehicle Advisor. Please wait for confirmation receipt for your request.

Thank you!

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