Salvage Title Odometer Disclosure Form
Vehicle Information
Year
Make
Model
Vehicle Identification Number (VIN)
Body Style
Color
Current Odometer Reading
Odometer Reading
The odometer reading reflects the actual mileage of the vehicle.
The mileage stated is in excess of its mechanical limits.
The odometer reading is not the actual mileage. Warning: Odometer Discrepancy.
Seller Information & Certification
Seller Name (Print)
Seller Address
Seller Signature
Date
Buyer Information & Acknowledgment
Buyer Name (Print)
Buyer Address
Buyer Signature
Date