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First Name
Last Name
Birthday
Residence Address
Type of Residence
Owned
Rented
Mortgage
Occupation
:
Office work
Homemaker (housewife, househusband)
Sales / Marketing
Others (Please specify)Others (Please specify)
Office Address
:
Work responsibility/Position
Telephone no
:
Mobile nos
:
E-mail Address
:
Expiration Date of Current Insurance Policy
:
Overnigh
:
Residence with locked garage
ResidenceResidence within subdivision / village
Neither of the above
Office Parking
Covered
Open
Where did you learn about Pink Wheels
:
Print Ads / Billboard / Yellowpages
Referred by a friend or relative
Internet, search engine
I am an existing client
Vehicle Description
Year
:
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Brand
:
Audi
BMW
Chana
Cherry
Chevrolet
Chrysler
Dodge
Ferrari
FORD
FOTON
Great Wall
Honda
Hyundai
ISUZU
JAC
JEEP
KIA
LAND ROVER
LEXUS
LIFAN
MAZDA
MERCEDES BENZ
MINI
MITSUBISHI
NISSAN
PEUGEOT
PORSCHE
SSANGYONG
SUBARU
SUZUKI
TOYOTA
VOLKSWAGEN
VOLVO
Model
:
A3 1.6L Gas M/T
A3 Quattro 3.2L Gas AWD 6Spd S-Tronic
A3 Turbo 2.0L Diesel 7Spd S-Tronic
A3 Turbo FSI 2.0L Gas 7Spd S-Tronic
A4 2.0L Gas CVT
A4 Avant 2.0L Gas CVT
A4 FSI Quattro 3.2L Gas 6Spd A/T
A4 Premium 2.0L Gas CVT
A4 Turbo 1.8L Gas CVT
A4 Turbo 2.0L Diesel CVT
A4 Turbo Avant 2.0L Diesel CVT
A4 Turbo FSI 1.8L Gas CVT
A4 Turbo FSI Premium 1.8L Gas CVT
A4 Turbo Premium 2.0L Diesel CVT
A4 Turbo Quattro 1.8L Gas 6Spd M/T AWD
A5 3.2L Gas CVT
A6 FSI 3.2L Gas CVT
A6 FSI Premium 3.2L Gas CVT
A6 FSI Quattro 4.2L Gas 6Spd A/T AWD
A6 Turbo FSI 2.0L Gas CVT
A6 Turbo FSI Premium 2.0L Gas CVT
A6 Turbo Quattro 3.0L Diesel 6Spd A/T AWD
A8 FSI Quattro 3.2L Gas 6Spd A/T AWD
A8 Quattro 4.2L Gas 6Spd A/T AWD
A8 Turbo 3.0L Diesel 6Spd A/T AWD
A8 W12 6.0L Gas 6Spd A/T AWD
Q5 Turbo FSI 2.0L Gas 7Spd A/T
Q5 Turbo FSI Premium 2.0L Gas 7Spd A/T
Q7 FSI Quattro S-Line 4.2L Gas 6Spd A/T AWD
Q7 Turbo Quattro 3.0L Diesel 6Spd A/T AWD
Q7 Turbo Quattro S-Line 3.0L Diesel 6Spd A/T AWD
R8 FSI 4.2L Gas 6Spd M/T AWD
R8 FSI Premium 4.2L Gas 6Spd M/T AWD
RS4 4.2L Gas 6Spd M/T AWD
S4 4.2L Gas 6Spd A/T AWD
TT FSI Quattro 3.2L Gas 6Spd A/T
TT Turbo 1.8L Gas 5Spd M/T
TT Turbo FSI Quattro 2.0L Gas 6Spd S-Tronic
TT Turbo Quattro 1.8L Gas 6Spd M/T AWD
Transmission
:
Manual
Automatic
Fair Market ValueFair Market Value
:
Plate noPlate no
:
eg. ABC-123eg. ABC-123
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