ODOMETER MILEAGE STATEMENT AFFIDAVIT
DIGITAL DASH SOLUTIONS 1-860-583-0629 FAX 1-860-383-8830
I, ________________________________________________________________________, STATE THAT THE
ODOMETER MILEAGE ON THE VEHICLE DESCRIBED BELOW READS, ____________________________ MILES
CHECK ONE ONLY
______ I hereby certify that to the best of my knowledge the odometer reading as stated above reflects the actual mileage of the vehicle described below.
______ I hereby certify that to the best of my knowledge the odometer reading as stated above is NOT the actual mileage of the vehicle described below and should not be relied upon.
DIGITAL DASH SOLUTIONS HAS ADVISED ME OF MY LEGAL OBLIGATION TO NOTIFY PROSPECTIVE PURCHASERS THAT THIS VEHICLE’S MILEAGE HAS BEEN ALTERED. I HAVE ALSO BEEN ADVISED THAT CHANGING MILEAGE FOR PERSONAL GAIN IS A SERIOUS OFFENSE FOR WHICH I MAY BE PROSECUTED.
YEAR, MAKE & MODEL: ________________________________________________________________________
VIN NUMBER: ________________________________________________________HOURS: _________________
MY REASON FOR ALTERATION IS
___THE ORIGINAL MILEAGE HAS BEEN CORRUPTED
___A REPLACEMENT CLUSTER IS TO BE INSTALLED COPYING THE ORIGINAL DATA IS REQUIRED
___OTHER_______________________________________________________________________________________
_______________________________________________________________________________________________
DIGITAL DASH SOLUTIONS RESERVES THE RIGHT TO REFUSE ANY WORK AND WITHOUT EXPLANATION. I/WE ACCEPT THE ABOVE TERMS AND CONDITIONS. I/WE ARE FULLY AWARE OF THE LEGAL IMPLICATIONS IMPOSED. I FULLY AGREE THAT DIGITAL DASH SOLUTIONS AND ITS EMPLOYEES, OFFICERS, AGENTS, REPRESENTATIVES SHALL BE HELD HARMLESS FROM ANY AND ALL CLAIMS, ACTIONS, CAUSE OF ACTIONS, DEMANDS, RIGHTS, DAMAGES, AND ATTORNEY FEES RELATING TO OR ARISING OUT OF DIGITAL DASH SOLUTIONS WORK ON THE ODOMETER.
SIGN: _____________________________________PRINT: _____________________________DATE: _________
ADDRESS: __________________________________________________________________________________
CITY____________________________________________________ STATE _________ ZIP ________________
MOBILE#__________________________HOME_________________________WORK______________________
___ BANK CHECK, PERSONAL, BUSINESS OR MONEY ORDER ACCEPTED.
___CREDIT CARD (INCLUDING DEPOSIT) AMOUNT APPROVED $_______________
CARD NUMBER _______________________________________________________________________________
NAME ON CARD_______________________________________________EXP_______________CVV_________
BILLING ADDRESS ______________________________________________________________________________
YOU MUST CALL US TO CONFIRM THAT WE RECEIVED THIS FORM, ITEM WILL NOT SHIP WITHOUT CONFIRMATION.