Free Michigan Category Weight Template in PDF

Purchase Date

Stock Number

Delivery Date

Title Only

Dealer:

Plate Number

Plate Expiration Date:

Months

New Plate

Month

Day

Year

Renewal

Street Address:

Transfer

City:

Year

Make

Body Style

County of

Residence

County:

State: MI

ZIP Code:

Vehicle Identification Number

Base MSRP or Empty Weight

License Plate Fee

Dealer License Number

Sales Tax License Number

Phone Number

Driver License, PID, or FEIN Number of All Owners or Lessees

Plate Transfer Fee

Vehicle Sold:

New

Used

Demo

Trade-In

Yes

No

1)

2)

3)

Title Fee

Trade-In Year

Trade-In Make

Vehicle Identification Number (VIN)

Complete Names and Address of All Owners or Lessor

Title Late Fee: $15 ($100 for

Vehicle Registration to Transfer Plate

B dealer floor planned vehicles)

Expires 15 Days After Delivery Date

Plate Transferred From:

Year

Make

Sales Tax

Vehicle Identification Number (VIN):

Plate Number:

Complete Names and Address of All Lessees

Total - Transfer to Line 5

0.00

Vehicle History and Title Brand Disclosure

Full Rights to Survivor

Police Vehicle

Vehicle Has Been Flood Damaged

Yes

No

Municipal Vehicle

Salvage Title Was Previously Issued

Michigan No-Fault Insurance Company

Policy or Binder Number

Taxi

Odometer Mileage Disclosure

Secured Interest:

Lien Filing Date:

The odometer mileage reading must match the mileage reading disclosed to the

purchaser on the title or mileage statement.

Street Address:

Actual Mileage

Exempt

Lien Code ID:

No Tenths

Not Actual Mileage

City, State, ZIP:

I have selected and agree

1. Purchase Price of Vehicle (Including Freight & Accessories)

to pay the OPTIONAL $24

2. Other Taxable Charges (Documentary, Service, Temp. Reg. Fees, etc.)

Remarks:

electronic filing fee

Customer Initials

2a. Optional Electronic $24 Filing Fee

......................................................3. Trade-in Sales Tax Credit

0.00

4. Total Taxable Price (Line 1 + Line 2 + Line 2a - Line 3)

0.00

5. Sales Tax + Plate Fee + Title Fee (From Total Above)

6. Non-Taxable Charges (Labor, Service Contract, etc.)

0.00

7. Total Delivered Price (Line 1 + Line 2 + Line 2a + Line 5 + Line 6).

8. Cash on Deposit

9. Cash Due on Delivery

Used Vehicle Dealers Only

10. Trade-In

$

0.00

$

0.00

11. Minus Lien

Floor Planned Inventory Lender:

0.00

12. Total Down Payment

Recreation Passport?

Yes

No

Purchaser or Lessee’s Initials:

0.00

13. Unpaid Balance To Be Financed

14. Insurance/Additional Product Charge*

I certify this vehicle was delivered to the named purchaser or lessee on the

0.00

15. Total Amount Of Finance Contract (Line 13 + Line 14)

delivery date indicated above, all information on this form is accurate and the

vehicle is subject only to the secured interest listed on this form. I certify the

*Warning: This Insurance is not PL/PD No-Fault Insurance required by Michigan law.

dealership will apply for title and registration in the purchaser’s name within

Credit Life Insurance

Health & Accident Insurance

15 days of the delivery date, and that I have provided paper or electronic

Gap or Waiver

copies of all signed documents to the purchaser.

X

15-Day Temporary Registration Number (this number may be handwritten)

c

Signature of Dealer’s Agent

Printed Name of Salesperson

Printed Name of Dealer’s Agent

Title

X

X

X

Purchaser or Lessor’s Signature

Date

Co-Purchaser’s Signature

Date

Co-Purchaser’s Signature

Date

X

X

X

Lessee’s Signature

Date

Co-Lessee’s Signature

Date

Co-Lessee’s Signature

Date