UVA Email * Name * Department Name and Number * Phone Number * Delivery Address * Departmental Vehicle Number * Purchase Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20232024202520262027 Year, Make, Model * VIN # * Body Type * Odometer Reading * Sale Price * Temporary tag expiration date - if no temp tags, put submission date. * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20232024202520262027 Fuel Type * Fuel Card Needed? * Yes No Planned Drop-off Date of Certificate of Origin/Title/Odometer Disclosure/Bill of Sale * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20232024202520262027 Have you informed the UVA Auto Insurance Program? * Yes No Have you contacted the Branding department to arrange installation of fleet marks? * Yes No What WorkTag should be charged the $30 titling fee? * Leave this field blank
