Participant Information

* Vehicle Owner First Name: *

* Address: *

* City: *

* Postal Code: * *

* Email: * Please enter a valid email address.

* Phone: * * * Please enter a valid phone number. Please enter a valid phone number. Please enter a valid phone number.

* Vehicle Owner Last Name: *

Apt. Number:

* Province: *

* Confirm Email: * Please enter a valid email address. The email and confirm email address must match.

* Additional Phone: Please enter a valid phone number. Please enter a valid phone number. Please enter a valid phone number.

Pickup Address same as above

* Pickup Contact First Name: *

* Address: *

* City: *

* Postal Code: * *

* Phone: * * * Please enter a valid phone number. Please enter a valid phone number. Please enter a valid phone number.

* Pickup Contact Last Name: *

Apt. Number:

* Province: *

Vehicle Information

* VIN: *

* Year: *

* Make: * *

* Model: * *

* Colour: *

* Kilometers: *

Condition of Vehicle:

	Running
	Complete with no missing parts
	Towable

Additional Notes:

Attachment

You can upload up to 5 photos of your vehicle (.jpg or .png formats less than 1 MB in size) to help auto recyclers evaluate your vehicle for bidding purposes.

Declarations

The following conditions must be agreed upon to participate.
*		* I hereby declare that I am the legal owner of the above vehicle, and that I have the absolute right to to transfer ownership and possession of the vehicle.
*		* I confirm and agree that the vehicle is free and clear of all liens and encumbrances.
*		* I agree to indemnify the Automotive Recyclers of Canada and applicable auto recyclers harmless from cost, damage or expense incurred.

Notes

Vehicle registration must match Vehicle Owner
Cheques will be issued to the Vehicle Owner only
Original ownership and keys must be presented to the recycler upon pickup of the vehicle
Vehicle Owner or designated Contact must be present to accept payment