VEHICLE AND OWNER IDENTIFICATION ; SPEEDOMETER REPLACEMENT RECORD - Page 6

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VEHICLE AND OWNER IDENTIFICATION 

Owner’s Name 

Date of Retail Delivery or First Use 

Address

After the speedometer is replaced, total mileage should be determined by adding the 
mileage listed here to the current mileage shown on the speedometer installed. 

Month Day 

City

Miles

State

Name of Selling Dealership 

SPEEDOMETER REPLACEMENT RECORD 

Speedometer replaced on 

Mileage at Delivery 

Vehicle Identification Number 

Year

Zip Code 

Phone

-

(                ) 

Dealer Code 

with

Miles

date

Dealer Name 

Dealer Signature 

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