solicitud de compra en ohio

SOLICITUD DE COMPRA EN OHIO
Buyer #: __________________
Número de comprador si ya está inscrito
DECLARATION PURSUSANT TO OH REVISED CODE SEC. 4738.021(A)(3)
(FOREIGN AND QUALIFYING OUT OF STATE)
Buyer Information
Nombre del negocio
Company Name: _________________________________________________________________________________________
Nombre del dueño de la cuenta
Owner (officer, partner) Name: ______________________________________________________________________________
Dirección
Street Address:___________________________________________________________________________________________
City: _________________________________________________ State: ____________ Zip: _____________________________
País
Country: ___________________________________________
THE ABOVE NAMED BUYER (“BUYER”) DOES HEREBY DECLARE, UNDER PENALTY OF PERJURY, THAT THE BUYER IS
AUTHORIZED TO PURCHASE SALVAGE VEHICLES IN THE BUYER’S HOME JURISDICTION AND THAT THE BUYER’S
HOME JURISDICTION ISSUES NO LICENSE WITH RESPECT TO SUCH PURCHASES.
Firma del dueño de la cuenta
____________________________________________
(Signature)
S
E
U
Puesto en la compañía
____________________________________________
(Title)
A
R
T
Fecha
____________________________________
(Date)
Note: This form is to be used by a used motor vehicle dealer, automotive recycler, salvage dealer, salvage dismantler, junk
yard, scrap metal processing facility authorized to purchase salvage motor vehicles by another state, country, or jurisdiction.
M
Buyer #: __________________
DECLARATION PURSUSANT TO OH REVISED CODE SEC. 4738.021(A)(3)
(FOREIGN AND QUALIFYING OUT OF STATE)
Buyer Information
Company Name: _________________________________________________________________________________________
Owner (officer, partner) Name: ______________________________________________________________________________
Street Address:___________________________________________________________________________________________
City: _________________________________________________ State: ____________ Zip: _____________________________
Country: ___________________________________________
THE ABOVE NAMED BUYER (“BUYER”) DOES HEREBY DECLARE, UNDER PENALTY OF PERJURY, THAT THE BUYER IS
AUTHORIZED TO PURCHASE SALVAGE VEHICLES IN THE BUYER’S HOME JURISDICTION AND THAT THE BUYER’S
HOME JURISDICTION ISSUES NO LICENSE WITH RESPECT TO SUCH PURCHASES.
____________________________________________
(Signature)
____________________________________
(Date)
____________________________________________
(Title)
Note: This form is to be used by a used motor vehicle dealer, automotive recycler, salvage dealer, salvage dismantler, junk
yard, scrap metal processing facility authorized to purchase salvage motor vehicles by another state, country, or jurisdiction.