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Get Vinassist 2020-2024

Phone: 802.828.2000 Toll Free: 888-998-3766 TTD: 711 Please refer to the instructions on the back of this form. SECTION 1: TO BE COMPLETED BY THE APPLICANT. Current Owner's Name Mailing Address - Street, Box, RD Daytime Phone (Include Area Code) ( City, State & Zip Code ) Evening Phone ( (Include Area Code) ) Email Address Make Model Year (YYYY) Body/Hull Type Vessel Length Ft. Current Registration Number (if applicable): Is this a Salvage Motor Vehicle/ Vessel/ATV/Snowmobile.

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