CONTACT DETAILS
COMPANY NAME
CONTACT NAME
STREET ADDRESS
CITY, PROV/STATE
PHONE
POSTAL CODE/ZIP
EMAIL
COUNTRY
ASKING PRICE
(INCL. COMMISSIONS)
BOTTOM LINE
(INCL. COMMISSIONS)
TRUCK SPECIFICATIONS
YEAR
ENGINE MAKE
VIN
ENGINE HRS
MAKE
MILEAGE
MODEL
ENGINE HP
TRANS. TYPE
A/C FUNCTION
YES
NO
TRANS. SPEED
TRUCK DELETED
YES
NO
TRUCK: Change/Overhaul/Rebuild
LIST
DATE
COMMENT
PUMP SPECIFICATIONS
YEAR
BOOM LENGTH
SERIAL #
SECTIONS
BRAND
PUMP KIT
MODEL
PROPORTIONAL
YES
NO
FOLD STYLE
Z-FOLD
R-FOLD
RZ-FOLD
ZR-FOLD
ZZ-FOLD
RADIO REMOTE
YES
NO
2ND REMOTE
CYLINDER SIZE
PUMP HOURS
PUMP: Change/Overhaul/Rebuild
LIST
DATE
COMMENT
COMPLETE EVALUATION
EXCELLENT
VERY GOOD
GOOD
FAIR
GENERAL OPERATIONS -
TRUCK
GENERAL CONDITION -
TRUCK
CAB EXTERIOR CONDITION
CAB INTERIOR CONDITION
FRONT TIRES PERCENTAGE
FRONT TIRES PERCENTAGE
GENERAL OPERATION -
PUMP
OVERALL CONDITION -
PUMP
PTO CONDITION
PTO VALUE
WEAR PART VALUE
MATERIAL CYLINDERS
BOOM SYSTEM
AGITATOR
HOPPER CONDITION
PAINT CONDITION
ADDITIONAL PARTS/NOTES
ITEMS INCLUDED WITH UNIT:
YES
NO
TOOL BOX
TIP HOSE
OUTRIGGER PADS
SPARE REMOTE
WATER HOSE
ITEMS BEING SOLD INCLUDES THE FOLLOWING:
DATE OF EVALUATION:
D D M M Y Y Y Y
COMPLETED BY:
BOOM CERTIFIED:
YES
NO
DATE BOOM LAST INSPECTED:
EXPIRY DATE OF LAST COMMERCIAL VEHICLE INSPECTION:
SUBMIT FORM