Commercial Vehicle Odometer Statement
Seller Name Seller Address Buyer Name Buyer Address
Vehicle Information
Year
Make
Model
Body Type
Vehicle Identification Number (VIN)
Odometer Reading
Odometer Disclosure Statement
(I/we hereby certify, to the best of my knowledge, that the odometer reading reflects the actual mileage of the vehicle described above unless one of the following statements is checked.)
The mileage stated is in excess of its mechanical limits.
The odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY.
Seller's Signature
Date
Buyer's Signature
Date