CONSIGNMENT FORM

*Please remove plates. Any plates left with vehicle will be

destroyed. IAA cannot guarantee vehicle will not be forked*

CUSTOMER INFORMATION
DEALER/SELLER NAME ASSIGNING REP

ADDRESS CITY/STATE/ZIP

PHONE 1 PHONE 2

EMAIL ADDRESS FEDERAL TAX ID

VEHICLE INFORMATION
YEAR MAKE

MODEL COLOR

VIN VEHICLE MUST BE ACCESSIBLE. IS IT ACCESSIBLE FOR PICKUP

AFTER SALE? □ YES □ NO
MILEAGE ______________ STATE ___________
□ ACTUAL □ EXCEEDS □ CLEAR □ REBUILT
□ NOT ACTUAL □ INOPERABLE DIGITAL DASH □ SALVAGE □ FLOOD
□ OTHER _________________ □ OTHER _______________

□ KEYS □ RUN & DRIVE □ STATIONARY START □ STARTS WITH JUMP □ WON’T START

VEHICLE DAMAGE CODE INFORMATION (Seen, Unseen or Repaired: check all that apply)
□ ALL OVER □ BOTH SIDES □ ELECTRICAL □ ENGINE BURN □ ENGINE □ EXTERIOR BURN
DAMAGE
□ FLOOD □ FRAME □ FRESH WATER □ FRONT END □ FRONT & REAR □ HAIL
□ INTERIOR □ LEFT FRONT □ LEFT & RIGHT □ LEFT REAR □ LEFT SIDE □ MECHANICAL
SIDE
□ REAR □ REPOSSESSION □ RIGHT FRONT □ RIGHT REAR □ RIGHT SIDE □ ROLL OVER
□ ROOF □ SALT WATER □ STORM □ STRIPPED □ SUSPENSION □ THEFT
DAMAGE
□ TOTAL BURN □ TRANSMISSION □ UNDER- □ UNKNOWN □ VANDALIZED □OTHER _______
CARRIAGE
□ MISSING PARTS: __________________________________________________________________________
VEHICLE AIRBAG STATUS
DRIVER PASSENGER DRIVER SIDE PASSENGER SIDE OTHER ___________
□ INTACT □ INTACT □ INTACT □ INTACT □ INTACT
□ DEPLOYED □ DEPLOYED □ DEPLOYED □ DEPLOYED □ DEPLOYED
□ MISSING □ MISSING □ MISSING □ MISSING □ MISSING
All bids are finalized by 12 noon the day after the sale. It is YOUR responsibility to contact our office to finalize the sale before
that time. After that time, IAA cannot guarantee the sale of the vehicle even if the bid has been approved.

MINIMUM BID SALE PROCEEDS

□ MAIL CHECK □ PICK-UP CHECK FROM BRANCH
FOR TERMS AND CONDITIONS, SEE REVERSE SIDE. **INTERNAL USE ONLY**
I confirm that I have thoroughly read and agree to be bound by the IAA Vehicle
Consignment Form’s Terms and Conditions, which are incorporated into this STOCK # ______________________
agreement. The IAA Vehicle Consignment Form’s Terms and Conditions can be found
on the back of this form, in any US located IAA branch or on our website SALE DATE ____________________
at www.IAAI.com.
OLD STOCK # __________________

BUYER # ______________________
_________________________ ___ ______________________________
SELLER SIGNATURE / DATE COMPANY NAME / TITLE SALVAGE PROVIDER # ___________

INSURANCE AUTO AUCTIONS: Please send completed form to Jermain Rose at one of the following:
1 E: [email protected] | F: 877.739.0229
Cell: 602.370.4556
 CONSIGNMENT FORM
*Please remove plates. Any plates left with vehicle will be
destroyed. IAA cannot guarantee vehicle will not be forked*

IAA VEHICLE CONSIGNMENT AGREEMENT TERMS AND CONDITIONS

1. Seller appoints IAA as its Agent to sell the vehicle and authorizes the sale of the subject vehicle.

2. Seller shall pay all fees, whether the vehicle sells or not, and agrees to pay any cost of collection (including collection
agency fees and/or court costs and attorney’s fees) in the event of Seller’s failure to pay all fees.

3. IAA shall re-run the vehicle for an additional sale fee unless Seller approves the vehicle for sale or informs IAA not to re-run
the vehicle and removes the vehicle from IAA’s premises by 2:00 PM on the day after the date of sale.

4. Seller shall not bid on the subject vehicle if prohibited by applicable law.

5. IAA shall remit vehicle sale proceeds to Seller, minus applicable Seller fees, no sooner than seven business days and no
later than twenty-one business days from the date IAA receives payment from the purchaser.

6. Seller represents and warrants that Seller is the sole registered and legal owner of this vehicle, and title to the vehicle is
valid, transferable and unencumbered.

7. Seller represents and warrants that all vehicle information provided is complete and accurate.

8. Seller shall maintain insurance on the subject vehicle and waives any claims against IAA for damage that occurs to the
subject vehicle while being held for sale, including damage due to vandalism, theft, flood, fire or any act of God.

9. Seller represents that all component parts are original, except as noted below, and that the vehicle contains no stolen
parts.

10. Seller shall indemnify, defend, and hold IAA harmless from and against any claims, demands, lawsuits, or liabilities
(including freight, attorney’s fees and defense costs) arising from or related to the sale of this vehicle, from the condition,
title, mileage, or history of the vehicle or any component part of the vehicle, or any misrepresentation, concealment or
omission of facts by Seller.

11. Seller represents that no vehicle identification numbers have been tampered with, replaced, or altered on the subject
vehicle.

12. Written authorization of the parties shall be required to vary the terms hereof.

13. IAA shall not be liable to Seller for consequential, special, incidental, indirect, punitive, exemplary, or other damages of any
kind (including lost revenues or profits, loss of business or loss of data) even if IAA is advised beforehand of the possibility
of such damages. Seller agrees that the liability of IAA and its subsidiaries, officers, agents, employees, and affiliates arising
from or related to this agreement shall not exceed the fee Seller paid to IAA to consign this vehicle for sale.

14. Any dispute arising out of this agreement shall be litigated in the state/province and county and applying the laws of the
state/province of the IAA facility that stored the vehicle at the time of sale.

15. If any term or provision of this agreement is determined by a court of competent jurisdiction to be invalid or
unenforceable, the remainder of this agreement shall not be affected thereby, and each term and provision of this
agreement shall be valid and enforceable to the fullest extent permitted by law.

I confirm that I have thoroughly read and agree to be bound by the IAA Vehicle Consignment Form’s Terms and Conditions
which are incorporated into this agreement. The IAA Vehicle Consignment Form’s Terms and Conditions can be also be found at
any US located IAA branch or on our website at www.IAAI.com.

________________
SELLER INITIALS / DATE

INSURANCE AUTO AUCTIONS: Please send completed form to Jermain Rose at one of the following:
2 E: [email protected] | F: 877.739.0229
Cell: 602.370.4556