Intake Form
Street address 1
City
Postal code
Street address 2
State
Country
Your Info *
Pickup Info *
Vehicle Info
Company Name
Type of Insolvency
Consumer Proposal
Bankruptcy
No Filing
Your Name *
Your Email Address *
Your Phone Number *
Additional Notes
Secured Creditor
Pickup Contact Name *
Pickup Contact Email Address
Pickup Contact Phone Number *
Pickup Address
Pickup Instructions
Same As Your Info
VIN
Decode VIN
e.g. JH4KA8150MC012098
Year
Make
Model
Colour
Condition
Drivable
Not Drivable
Unsure
Drivetrain
Front Wheel Drive
4-Wheel Drive
Unsure
Ownership / Image / Document
Maximum Total Size: 20MB
Please ensure you fill out the minimum requred fields to continue.
Your Info - Your Name
Your Info - Your Email Address
or
Phone Number
Pickup Info - Pickup Contact Name
Pickup Info - Pickup Contact Phone Number
Please upload only
20MB
of files for Ownership / Image / Document
Submit