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Customer Intake Form

Auto Specialist: Kerry Patterson

Email: kerryp@consumerautoxchange.com

Phone: 770-355-9915

"*" indicates required fields

Seller's Information

Name*

First Last

Phone*

Email*

Seller's Address

Address*

Street Address Address Line 2 City State ZIP Code

Vehicle Information

Year

Make

Model

Vehicle Vin #*

Odometer Mileage*

Price Agreed to Pay*

Copy of your Vehicle Title and/or Registration*

Drop files here or

Max. file size: 100 MB.

Phone/Tablet Instructions: Select the "Take a Photo/Upload Files" button above. Then you can either take a picture or select an image from your photos.
Desktop Instructions: Scan the document or take a picture of it, and save it to your computer. Then, you can either drag the file over to the box above, or click "Upload Files" to select your image.

Copy of your Driver's License*

Drop files here or

Max. file size: 100 MB.

Phone/Tablet Instructions: Select the "Take a Photo/Upload Files" button above. Then you can either take a picture or select an image from your photos. Desktop Instructions: Scan the document or take a picture of it, and save it to your computer. Then, you can either drag the file over to the box above, or click "Upload Files" to select your image.