Vehicle Inspection Form - Save $$ Today

1 StateYearDate of InspectionNMSNMSNMSNMSNMSNMSNMSThis is to certify that the above inspections have been performed and all necessary repairs to DealerCopy to CustomerMakeModelDealership Authorized dealer signatureTitle / position cruise control A/C cooling brakesZipCityAddress 1 Address 2 Ratings are comparative with vehicles of like year and = NormalVehicle Under HoodName radio / CD / DVD / navigation gas cap antenna trailer towing / wiring harness jack, handle and lug wrench rear seat DVD 81-707-0002 (rev 02/15)VINP hone# brake hoses and lines struts / shocks front spare tire control arms and bushingsOdometer transmission / transaxle 4X4 operationalFax#E-MailVehicle Undercarriage (con't)Tech IDDealer CodeTest Drive / Performance engine performanceOtherComments modifications (note in comments) owner's manualM = Monitor / Watch power seats and controls wiper / washer rear front wiper blades front rearVehicle ExteriorS = Service RequiredVehicle Interior (con't)

2 Side / vent windows mirrors left right ball joints transaxle seals / gaskets fluid levels and conditions axle seals wheel bearings CV joints and boots engine seals / gaskets transmission seals / gaskets headlights / DRL / fog tire pressure monitors turn signals L R hazard / warning lights rotors / drums transfer case seals / gaskets water pump sun roof / power top / moon roof windshield / rear window belts hoses radiator / cap engine / trans mounts exhaust system power sliding doors and controls power lift gate and controls power windows and controls rear obstacle detection system driveshaft / U-joints DVD headphones / remote rack and pinion / steering gear A/C leaksVehicle Undercarriage front sway bar and bushings tie rod ends power mirrors and controls horn interior lighting remote start wheel guard socket hood / trunk release center link struts / shocks rear window / door handles steering column operation oil leaks coolant leaks door locks seat belts pitman arm / idler arm rear view mirror / self dimming power steering pump / hoses pads / shoes.

3 Front % rear % brake lights / tail lights L RVehicle Interior emergency brakeVehicle Inspection Form It is MANDATORY that all used vehicles are inspected and all required repairs are performed prior to the sale of a Mopar Vehicle Protection plan. Claims for repairs made to vehicles with pre-existing conditions will not be authorized for payment. 2WD 4WD