For location, please choose one of the following:

• CDJ of Baldwin
• CDJ of Gainesville
• CDJ of Lawrenceville

---




Vehicle Information

* Year: * Make: * Model: Trim: Body Style: Select One Sedan Hatchback Wagon Mini Van Convertible SUV Pickup Extended Cab Crew Cab Passenger Van Cargo Van * LOCATION: Odometer:

Transmission: Select One Automatic Manual Exterior Color: Interior Color: Current Monthly: Payoff Balance: Estimated Value:

Installed Options

ABS Brakes Air Conditioning AM/FM Stereo Cassette Single CD Multi CD Integrated Cellular Navigation System Cruise Control 4 Wheel Drive Leather Power Locks Power Windows

Power Seats Tilt Wheel Rear Air/Heat Air Bag Dual Air Bags Alloy Wheels Premium Wheels Wheel Covers Luggage Rack Sun Roof Moon Roof Anti-theft

Video System DVD System Privacy Glass Bra Running Boards Third Seat Towing Package Bed Liner Short Bed Long Bed Sliding Rear Window Dual Rear Wheels

Contact Information

* First Name:		* Last Name:
* Email:		Home Phone:
* Day Phone:		Fax:
Cell Phone:		* Preferred Contact:			Email Home phone Day phone Cell phone Fax
Address:
City:		State:	Select One AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA ME MD MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY	* ZIP Code:

Vehicle Condition

Please rate the overall condition of your vehicle. "Excellent" indicates that your vehicle is in excellent mechanical condition, has glossy paint and a perfect interior. "Good" indicates that your vehicle is free of any major defects and has only minor visual blemishes. "Fair" indicates that the vehicle has some mechanical or cosmetic defects but is in safe running condition. "Poor" indicates that the vehicle has severe mechanical and/or cosmetic defects.

Overall Condition:

Excellent

Good

Fair

Poor

Exterior Condition

Please rate the exterior condition of your vehicle.

Body:		Excellent		Good		Fair		Poor
Paint:		Excellent		Good		Fair		Poor
Glass:		Excellent		Good		Fair		Poor
Rust:		Excellent		Good		Fair		Poor
Lights/Lenses:		Excellent		Good		Fair		Poor
Comments:

Interior Condition

Please rate the interior condition of your vehicle.

Carpet:		Excellent		Good		Fair		Poor
Upholstery:		Excellent		Good		Fair		Poor
Heating & A/C:		Excellent		Good		Fair		Poor
Power Accessories/Instruments:		Excellent		Good		Fair		Poor
Comments:

Mechanical Condition

Please rate the mechanical condition of your vehicle.

Engine:		Excellent		Good		Fair		Poor
Transmission:		Excellent		Good		Fair		Poor
Suspension:		Excellent		Good		Fair		Poor
Steering:		Excellent		Good		Fair		Poor
Brakes:		Excellent		Good		Fair		Poor
Tires:		Excellent		Good		Fair		Poor
Comments:

Additional Vehicle Information

Title History:	Select One Clean Branded Salvage etc.
Emissions:	Select One Current Failed/Gross Polluter
Odometer Reading:	Select One Accurate Reset/Rolled Over
Registration:	Select One Current Expired/Fees Due
Service Maintenance:	Select One On time and current Some done Not done
Service Records:	Select One All available Some available Not available
Body Repair Done:	Select One None Minimal Major
Additional Information:

* These fields are required

Hayes Chrysler Dodge Jeep of Lawrenceville Home Page – Serving Atlanta