Address
City, State Zip	, LA
Recording a lien?	Yes No If yes, lien type UCC-1 Other
Sale Date	(mm/dd/yyyy)
Sale Price
Rebate
Trade In
Vehicle Type	Car/SUV Commercial Truck Boat Trailer (up to 1500 lbs) Motorcycle Other Trailer - 1 year plate Trailer Other Trailer - 4 year plate Motorhome Other Trailer - permanent plate
Are you a Louisiana dealer that currently does business with Pedersen Auto Title Company LLC? Yes No
Are you an out of state dealer that currently does business with Pedersen Auto Title Company LLC? Yes No
Will you need your documents mailed? Yes No
Do you have a current specialized plate that you would like to transfer to this vehicle? Yes No