■ Column for Customer's Information
・Name and
Family Name
(Must input )
・Address
・ Return Reply
(Must input )
TEL
FAX E-mail
・TEL
・FAX
・E-MAIL
・Birthday
Year month day
■ Your request for car
・First Registration
Year
year month ※Contents written in car inspection certificate
・Formality on Car Inspection certificate
※Contents written in car inspection certificate
・Car Name
・Grade
・Engine size
cc
・Body Color
・Mileage in Km
Km
・Next inspection
year month
・Car maintenance
record
(Must input )
owning not owning
・Previous Owner
Number
(Must input )
one two others
・Transmission
AT MT
・Right hand or
Left Hand Drive
left right
・Numbers of doors
2 doors 3 4 5 others
・Wheel drive
4WD 2WD
・fuel
Gasoline light oil
・Other Equipments
(multiple items allowed)
air bugs TV ABS navigation system
CD aero parts leather seats aluminum wheels
sun roof
MD
・Car Accident History
nothing something
・Loan Outstanding
nothing something about $
・Way of Purchase
(Must input )
Imported car through Japanese Official Dealers
Imported car through Overseas Dealers
・Approximate Budget
US$
・Current Owner
myself Loan company
・Others and question, if you have.