Casual Automobile (Non-Dealer) Purchase Agreement
and Seller Proof-of-Ownership Information
SELLER INFORMATION: The seller agrees to sell vehicle to buyer according to the facts stated herein.
Seller’s Name(s) /
Address City/State/Zip
Home Telephone ( ) Work Telephone ( )
TITLE AND LIEN INFORMATION: Odometer reading as of (date)
This item is presently titled in the State of Title # Date
Seller Check One:
I hereby swear the vehicle being sold has NO liens or encumbrances.
There is presently a lien on the above with: Financial Institution
Payoff amount of $
Address
Loan Account #
City/State/Zip
Telephone ( )
Signature of Seller(s) Date
VEHICLE DESCRIPTION: Auto Truck RV Other OPTIONS: (please
check) 4W Drive
Anti Lock Brakes Tilt Manual
Year Make Power Steering Cruise Automatic
Power Door Locks Air
Model/Type (LX,EX) Power Windows Leather Seats 2-Door
Power Driver Seat Moon Roof 4-Door
Selling Price $ VIN # Cassette Sliding Sunroof
CD Player Custom Wheels
PURCHASER INFORMATION: Account Number
Purchaser’s Name(s) /
Address City/State/Zip
Home Telephone ( ) Work Telephone ( )
/
Name(s) in which vehicle will be titled:
State where vehicle will be titled: Amount Financed $
Signature of Purchaser(s) Date
AUTO INSURANCE INFORMATION:
Insurance Company Policy #
Agent’s Name
Telephone ( )
Tides (klm Loans\CAPA.P65) Rev 1/10/02