COVER SHEET FOR DUPLICATE MCO REQUEST

COVER SHEET FOR DUPLICATE MCO REQUEST
(To be submitted with application)
LINDA KPORWODU
VOLKSWAGEN ACCOUNTING SERVICES
777 BAYLY ST. WEST
AJAX, ONTARIO, CANADA L1S 7G7
Phone # (905) 428-5849
Fax # (905) 428-5834
Linda.Kporwodu@vw.ca
DATE_____________________
# OF PAGES:_______________
DEALER NAME: ________________________________________________________
VW/AUDI/BENTLEY DEALER NUMBER__________________________________
REQUESTOR’S TELEPHONE NUMBER:_______________________EXT. #:_____
REQUESTOR’S NAME: __________________________________________________
PLEASE PRINT NAME
REQUESTOR’S EMAIL ADDRESS: ________________________________________________________
SEND MCO BY:
FEDERAL EXPRESS:
#_____________________________________
UPS Account Number:
#_____________________________________
REGULAR MAIL (allow 10-15 business days for delivery)
IF REQUEST IS REGARDING A VEHICLE WHO’S ORIGINAL DEALER
IS ONE OF THE FOLLOWING (MILITARY SALES, LEASE
PLAN/FLEETOR COURTESY DELIVERY / BUYBACK), PLEASE
CONTACT A REPRESENTATIVE FROM EACH RESPECTIVE AREA.
FAILURE TO INCLUDE YOUR FED-EX/UPS ACCOUNT NUMBER, WILL AUTOMATICALLY
GUARANTEE THAT THE REPLACEMENT MCO WILL BE SENT BY REGULAR MAIL.
INSTRUCTIONS:
PLEASE COMPLETE THE ATTACHED APPLICATION, FAX A COPY TO US AND
SEND THE NOTARIZED ORIGINALS BY REGULAR MAIL TO THE ADDRESS
ABOVE.
This form is also available at: http://vw.invoicecopy.com
APPLICATION FOR DUPLICATE MANUFACTURER’S CERTIFICATE OF ORIGIN
TO A MOTOR VEHICLE
The undersigned (“Applicant”) hereby applies to Volkswagen of America, Inc.
(“VWoA”) for a duplicate of the “Manufacturer’s Certificate of Origin to a Motor Vehicle”
(“MCO”) for the vehicle described below (the “Vehicle”):
Make ___________________ Year _____________ Model _____________
Vehicle Identification Number _______________________________________
LIEN INFORMATION
If no lien, check this box:
To Whom Due:
Address:
_____________
______________________
Applicant represents and warrants:
1. Applicant is the lawful owner or lienholder of the motor vehicle;
2. The original MCO has never been assigned by Applicant; and
3. The original MCO has been lost, destroyed or not received
4. Other, please specify: ______________________________________
Applicant will indemnify, defend and hold harmless VWoA from and against any and all claims,
demands and costs arising out of VWoA’s issuance of a duplicate MCO.
Dated: __________________
Name of Corporation (if applicable):
______________________________________
By: ___________________________________
Print Name: ____________________________
Title: __________________________________
State of _________________________)
)
County of _______________________)
Subscribed and sworn to before me this _____ day of ______________ 20 _____.
___________________________
Notary Public
My Commission Expires: _______