CARS Qualifier
*First Name:  

*Last Name:   

*Address:        

*City:               

*State:             

*ZIP:                

*Phone:           

*Email:            

*Is your trade-in a 1984 or newer? (Must be a passenger car, minivan, SUV, or Pick-up Truck):          

*Are you buying a new vehicle that is less than $45,000? If so, what are you looking to buy?:               

*Is the vehicle your trading in drivable condition, insured, and registered to the same owner for at least 1 year?

*Does your trade-in get 18 mpg or less? (Visit www.fueleconomy.gov if you do not know):                    

*Does the vehicle you are buying get 22 mpg or more?(If the new vehicle you want gets 4 – 9 mpg more than trade-in you will receive $3,500; if the new vehicle you want gets 10+ mpg you will receive $4,500):                                              

*What is the model year of your trade-in?:                                                                                                 

*What is the make and model of your trade-in?:                                                                                         

*What is the engine size of your trade-in?:                                                                                                  

*Is you’re your first time using the Cash for Clunkers Program?: