Retirement Vehicle Information
Consumer Representations and Disclosures:
The vehicle described above is the vehicle to be retired and:
Is a gasoline or diesel powered light or medium vehicle.
I understand that I must retire my vehicle by transferring title to an authorized dismantler and provide proof of ownership and photo identification.
In addition to the requirements listed above, I understand that additional requirements may apply.
Under penalty of perjury, I certify that:
I am the owner of the vehicle and the title is free and clear of all leans.
My signature below gives express written consent to the company and/or its agents or designees to capture, use, study, report, and disclose information provided in this application and any related vehicle emissions data to other third parties as allowable under applicable federal, state, and/or local laws or regulations.
By submission of this document, I declare, under penalty of perjury, the information provided within this Application is true and correct.
You will need to provide the following documents:
Copy of Government issued photo ID,
Copy of vehicle title,
Documentation showing vehicle operation over the past year. (Current Registration),
Clear Photo of Vehicle