VERBAL REPORT TO:	MILEAGE:	PRODUCTION DATE:
DATE ON RO:	VIN #:	LABOR RATE:
RO NUMBER:	LICENSE PLATE:	LABOR PROVIDED: SELECT ONE Posted Verbal
RO NAME:	STATE: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	TOWED/DRIVEN: SELECT ONE Towed Driven

FLUID	LEVEL	CONDITION
ENGINE OIL	SELECT ONE Full Low Drained Empty Overfull N/A	SELECT ONE Good Fair Poor Burnt Intermixed Contaminated N/A
TRANSMISSIONS	SELECT ONE Full Low Drained Empty Overfull N/A	SELECT ONE Good Fair Poor Burnt Intermixed Contaminated N/A
COOLANT	SELECT ONE Full Low Drained Empty Overfull N/A	SELECT ONE Good Fair Poor Burnt Intermixed Contaminated N/A
RADIATOR	SELECT ONE Full Low Drained Empty Overfull N/A	SELECT ONE Good Fair Poor Burnt Intermixed Contaminated N/A
TRANSFER CASE	SELECT ONE Full Low Drained Empty Overfull N/A	SELECT ONE Good Fair Poor Burnt Intermixed Contaminated N/A
POWER STEERING	SELECT ONE Full Low Drained Empty Overfull N/A	SELECT ONE Good Fair Poor Burnt Intermixed Contaminated N/A
FRONT DIFF	SELECT ONE Full Low Drained Empty Overfull N/A	SELECT ONE Good Fair Poor Burnt Intermixed Contaminated N/A
REAR DIFF	SELECT ONE Full Low Drained Empty Overfull N/A	SELECT ONE Good Fair Poor Burnt Intermixed Contaminated N/A
BRAKE FLUID	SELECT ONE Full Low Drained Empty Overfull N/A	SELECT ONE Good Fair Poor Burnt Intermixed Contaminated N/A

ENGINE TYPE:

TRANSMISSION TYPE:

DRIVE TYPE: SELECT ONE 4WD AWD FWD RWD N/A

SERVICE STICKER:

SERVICE HISTORY AT SHOP:

COMMERCIAL USE? SELECT ONE Yes No	EVIDENCE OF TOWING? SELECT ONE Yes No	DISCOLORATION? SELECT ONE Yes No
MODIFICATIONS? SELECT ONE Yes No	SLUDGE VARNISH? SELECT ONE Yes No	OPERATOR PROTECT VEHICLE? SELECT ONE Yes No
ABUSE? SELECT ONE Yes No	SIGNS OF OVERHEAT? SELECT ONE Yes No	ANY PRE-EXISTING CONDITIONS? SELECT ONE Yes No
SIGNS OF COLLISION? SELECT ONE Yes No	LACK OF LUBE? SELECT ONE Yes No	LEVEL OF TEAR DOWN?

CURRENT TIRE SIZE:

FACTORY TIRE SIZE:

TIRE TREAD DEPTH:

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