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Vehicle 3 Information Sheet
Make
Model
Year
Color
Vin Number
License Plate Number
State of Registration
Description (Museum may utilize Owner’s description, but reserves the right to provide a description in any applicable catalogue, labels, and publications):
Condition of Automobile: Automobile is ready to display? yes? no? if no, please explain:
Insurance value: Estimated current market value in US$:
Insurance Company
Policy Number
Photography: Can you provide photographs of the automobile available for publicity?
Yes
No
Please note any special instructions
First Name
Email
Last Name
Phone
Select an Address
I accept terms & conditions of this placement agreement as stated above and on the attached "Conditions Governing placement" are accepted and agreed to:
Signature of Owner
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