SPEEDOMETER REPLACEMENT RECORD- Page 6

6

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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