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4
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Hirers Details
*Business Name:
*Contact Name:
*Tel No:
*Email:
Vehicle Information
*Make & Model:
*Engine etc:
*Doors:
*Reg No:
*Date of Reg:
*Mileage:
*No of Owners:
Accessories/Extras
( eg Leather / Air Con / Met paint / Alloys )
*Reg Documents:
Yes
No
*Imported Vehicle:
Yes
No
*Tax Valid to:
*Mot Valid to:
*Colour Ext:
*Colour Int:
*Fuel Type:
Petrol
Diesel
*Transmission:
Man
Auto
*Service History:
Full
Part
None
*Anticipated Value:
£
*Is the Vehicle on Finance:
Yes
No
Approx Settlement:
£
Damage Assessment
Please refer to the following diagram and enter an accurate damage report.
General Appearance
*Exterior:
Poor
Average
Good
*Interior:
Poor
Average
Good
Panel No
Faults or Damage
1 - Front right wing
2 - Front right door
3 - Rear right door
4 - Rear right wing
5 - Front bumper
6 - Bonnet
7 - Roof
8 - Boot
9 - Rear bumper
10 - Front left wing
11 - Front left door
12 - Rear left door
13 - Rear left wing
14 - Wheels
Vehicle Analysis
No Fault
Fault
If Fault Give Details
Engine
Gearbox
Suspension
Electrics
Exhaust
Clutch
Steering
Brakes
Battery
Accessories
( * Mandatory Field )
E-mail:
sales@lease4less.org.uk
Freephone: 0800 988 0199