Consignment Information Form

First Name *

Last Name *

Company Name

Address 1

Address 2

City *

State / Province *
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Postal / Zip Code *

Phone Number

Email Address *

Manufacturer *

Model *

Year *

Odometer *
HoursKilometersMiles

Length

Number of slide outs? ---012345more than 5

Is there a lien? * YesNo

If yes, what is the amount owed?

Selling Price *

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