VEHICLE AND OWNER IDENTIFICATION; SPEEDOMETER REPLACEMENT RECORD- Page 6

VEHICLE AND OWNER IDENTIFICATION

6

Owner’s Name

Date of Retail Delivery or First Use

Address

Month

Mileage at Delivery

Year

Miles

Day

City

Vehicle Identification Number

Name of Selling Dealership

Dealer Signature

Dealer Name

Speedometer replaced on

with

date

Miles

SPEEDOMETER REPLACEMENT RECORD

TEL   (               )          - 

Zip Code

Dealer Code

State

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.

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