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 Midland Cars Supplying Your Prestige Car
                                    Supplying Your Prestige Car
Cars Sold By Midland Cars

Part Exchange Details
YOUR DETAILS
Title:*
      
First Name(s):*
Surname:*
  
Tel Number:*
Mobile Number:
  
Email:*

 
YOUR CAR
Make:*
Model:*
 
Engine Size:*
Specification (eg SE)
  
Gearbox:*
Body Type:*
  
Fuel Type:*
Mileage:*
  
Reg Number:*
Date of Registration:*
  
No. of Owners:*
  
Service History:*
  
Last Service Date:
Next Service Date:
  
MOT Expiry Date:*
Road Tax Expiry Date
  
Exterior Colour:
Metallic:
  
Interior
Interior Colour
  
Air Conditioning
Climate Control
Cruise Control
Alloy Wheels
CD Player
Electric Windows
Central Locking
Power Steering
Sunroof
Sat Navigation
Parking Sensors
Electric Seats
Other Specification:
Vehicle Condition:
        
Has the vehicle been in an accident:*
    
Bodywork:*
Interior:*
Mechanical:*

Other Comments:
Declaration
To the best of my knowledge, the information I have provided in this form accurately reflects the current condition of my car.*
 


Midland House, Claines Garage, Droitwich Road, Worcester. WR3 7SW
Telephone Number : Office 01905 75 57 75  Mobile: 07908 208802
© Midland Cars 2007