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RideAway
mobility equipment
disabled equipment
 adaptive equipment

Sell Your Vehicle to Us

Please fill out the form below

Please Note: Ride-Away does not buy vans that are older than 10 years old unless it is part
of a trade in on a purchase.
* indicates required field

Your Information
Name: *
Address: *
City: *
State: *
Zip Code: *
Home Phone (with area code): *
Work Phone (with area code):

Vehicle Information
VIN#:
Trade-In: Yes    No
Year:
Make:
Color:
Engine:
Model:
Mileage:
Transmission:
All tires match?: Yes    No
Tread Depth:
Asking Price:

Vehicle Options
Power Windows: Yes    No
Power Door Locks: Yes    No
Air Conditioning: None    Front    Back    Both
Blowing Cold Air: Yes    No
Cruise Control: Yes    No
Fourth Door: Yes    No
Conversion Van Interior: Yes    No
If so, is it from OEM: Yes    No
Tilt Steering: Yes    No
Privacy Glass: Yes    No
Leather Seats: Yes    No
CD Player: Yes    No
Aluminum Wheels: Yes    No
Wheel Base: Short    Long
Side Door: Swing    Slide
Please list any problems with the interior

Conversion Components Information
Name of Conversion:
Raised Roof Top: None    Hi Top    Low Top
Running Boards: None    Aluminum
Metton    Fiberglass
Other Details

Handicap Modification Information
Raised Door: None    Side    Rear
If so, at what height:
Lowered Door: None    Full Drop    Driver Drop
Passenger Drop    Center Only
If so, at what height:
Lift Type:
Lowered Floor Mini-Van: Yes    No
Power Door: Yes    No
Kneel: Yes    No
6-Way: None    Driver    Passenger
6-Way Power Door: Yes    No
Exterior Switches: None    Toggle    Magnetic
Hand Controls (Type):
Wheelchair Tie-Downs (Type):
Number of Locations:
Reduced Effort: Steering:
Braking:
Modification done by:

*For the purpose of securing credit from you, I certify that the above information is true and complete to the best of my knowledge.  Applicant further certifies that I have attained the age of majority. 
Seller Signature:
Date:
E-mail: *