Cash Quote Simple Form | LongIslandCarForJunk.com

Customer Information

Full Name*

Zipcode where vehicle is located*

Your Email (For us to send a Guaranteed Cash Quote)*

Vehicle Information

Year*

Make*

Model*

Trim Level

The "Trim Level" is also known as a "Sub Model" such as LX, GT, SE, LIMITED, etc.

Color*

What is the approximate MILEAGE on the Odometer?*

Do you have the TITLE for this vehicle?*

Do you have KEYS for the vehicle?*

Do all the TIRES have air?*

Where are the FLAT TIRES located on the vehicle?*

Driver Side FRONT
Passenger Side FRONT
Driver Side REAR
Passenger Side REAR

Which WHEELS are MISSING?*

Driver Side FRONT
Passenger Side FRONT
Driver Side REAR
Passenger Side REAR

Does the vehicle START at this time?*

Are the Engine, Transmission and Battery complete under the hood?*

Is the BATTERY missing from the vehicle?*

Are the engine or transmission REMOVED from the car?*

What is missing under the hood?*

Does the vehicle DRIVE at this time?*

Do you know why the vehicle will not drive?*

Are any BODY PARTS (doors, bumpers, hood, etc.) LOOSE or MISSING from the vehicle?*

YES
No

Where are the LOOSE or MISSING panels located on the vehicle?*

Driver Side FRONT
Passenger Side FRONT
Driver Side REAR
Passenger Side REAR

Does the vehicle have any baseball-sized or larger DENTS or DAMAGE?*

YES
No

Where are the DENTS or DAMAGE located?*

Driver Side FRONT
Passenger Side FRONT
Driver Side REAR
Passenger Side REAR

Are any MIRRORS,GLASS or LIGHTS CRACKED or DAMAGED?*

YES
No

Where is the CRACKED glass located on the vehicle?*

Driver Side FRONT
Passenger Side FRONT
Driver Side REAR
Passenger Side REAR

Are any INTERIOR PARTS (seats, airbags, radio, etc.) MISSING from the vehicle?*

YES
No

Does the vehicle have any FLOOD or FIRE damage?*

YES
No

What is your ASKING PRICE for this vehicle?*

How did you hear about us?*

Please tell us how you heard about us*

(OPTIONAL) Include any extra information you would like us to know

Vehicle Offer Form

Customer Information

Vehicle Information