McKenzie’s Associated Auctioneers 1881 Scanlan Street                                      D#4322533 R# 078199565                                                      

1881 Scanlan Street, London, Ontario, N5W 6C3                    ph:519-453-7182        fax:519-451-2443 

Dealer #: __________  Lot #: _________                                     Sale Date: ____________________                             

Full Name: ______________________________________ Phone # on Auction Day: _____________________

Address: __________________________________________________________________________________

                                                   Street                                                                    City                                                        Province                              Postal Code

Year: ___________ Make: ______________    Radio:   AM     FM      CASS      CD     MISSING

Model: __________ Colour: _____________   

Body Style:        2 Door   4 Door    Van     Pickup            Transmission:    Standard           Auto          4WD

Engine:       b 4 Cylinder      b 6 Cylinder      b 8 Cylinder                   ( ) Gas         b Diesel                b Propane

 

  VIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b Power Steering          b  Power Mirrors                      ___________________________________________

b  Power Brakes           b Air Conditioning                  ____________________________________________           

b Power Locks             b Tilt Steering                          * Is odometer faulty,broken,replaced or rolled back ( )y ( ) n

b Power Windows        b Cruise Control                       if yes explain ___________________________________

b Power Antenna         b Sunroof                                 if distance travelled unknown, explain: _______________

b Power Seats              b Radio                           ___________________________________________

b Power Trunk              purchased from_______________     One owner ( )y ( )n     b Certified             b E-tested       

b Accident repair ( )    Accident Brand  ( ) none ( ) salvage ( ) rebuilt         Odometer: ____________ KMS   MILES TMU   

 

 

 

 

 

VIN Checked(Dash & Door)

 

Yes

 

No

Has Vehicle Ever Been Declared A

Within the last 7 Years was this an:

 

 

 

 

 

Original MFR. Vin Plate

 

Yes

 

No

Total Loss by an Insurer

 

Yes

 

No

Out of Province Vehicle

 

Yes

 

No

 

 

 

 

 

Registered Lien

 

Yes

 

No

Theft Recovery

 

Yes

 

No

U.S. Vehicle

 

Yes

 

No

 

 

 

 

 

 

 

Manufacturer’s Warranty Canceled

 

Yes

 

No

If Yes, Identify Province(s) and/or State(s):

 

Daily Rental

 

Yes

 

No

Police Cruiser

 

Yes

 

No

Anti-Lock Brakes Inoperable

 

Yes

 

No

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fire Damaged

 

Yes

 

No

Emerg. Services Vehilce

 

Yes

 

No

Air bags Missing/Inoperable

 

Yes

 

No

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Immersed in Water

 

Yes

 

No

Taxi/Limo

 

Yes

 

No

Pollution Control Inoperable

 

Yes

 

No

 

N/A

 

 

 

 

 

 

 

Any Body Panels Painted or Replaced

 

Yes

 

No

If Yes to Any, Explain:

 

Does Vehicle Require Repairs To:

 

 

 

If Yes To Any, Explain:

 

 

 

 

 

 

 

 

Engine

 

Yes

 

No

Computer

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

Suspension/Frame

 

Yes

 

No

Electrical System

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

Transmission

 

Yes

 

No

Air Conditioning

 

Yes

 

No

Other than Disclosed Herein:

 

 

 

 

 

 

 

 

 

 

 

Fuel System

 

Yes

 

No

Structural Parts Damaged, Altered or Repaired

 

Yes

 

No

Any Previous Damage Repaired Exceeding $3000?   (  ) y   (  ) n

 

 

 

 

 

 

 

Power Train

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have The Manufacturer’s Badges/Decals been Changed Or Have The Original Production Specifications Been Changed?

 

Yes

 

No

 

 

 

 

 

 

 

Any Other Disclosures? :

 

Commission:  8% OR $85.00 minimum + lien check if vehicle sells       $25.00 + HST if doesn’t sell.

RESERVE PRICE $___________________ I declare that my consignment has not been accident damaged, nor was such information disclosed when purchased/leased.

My Consignment does not have any mechanical defects                 

Signature of Registered Owner(Consignor)__________________________________