MAZDA NEW VEHICLE PRE-DELIVERY CHECKLIST Click Here for Out of State/TLC Vehicles Pre-Delivery Checklist (Mazda) MAIN CONTACT INFORMATION Please fill out Customer Information exactly as it appears on his or her driver's license. Delivery Date * Anticipated Date of Delivery Estimated Time of Delivery 121234567891011 : 00153045 AMPM Salesperson * ARIF MIAH • 646-764-5909 • AMIAH@KOEPPELAUTOGROUP.COMBEN EHRLICH • 917-409-5160 • BENE@KOEPPELAUTOGROUP.COMDIBEEN PANDEY • 347-617-0396 • DPANDEY@KOEPPELAUTOGROUP.COMGIUSEPPE MONOMO • 929-451-8017 • GBONOMO@KOEPPELAUTOGROUP.COMJAMES HUANG • 646-923-4836 • JHUANG@KOEPPELAUTOGROUP.COMJAY POLANCO • 516-262-2506 • JPOLANCO@KOEPPELAUTOGROUP.COMJIM MENDEZ • 718-775-0432 • JMENDEZ@KOEPPELAUTOGROUP.COMRAKIB KAZI • 347-257-1459 • RKAZI@KOEPPELAUTOGROUP.COMRAUL JIMINIAN • 347-556-4864 • RJIMINIAN@KOEPPELAUTOGROUP.COMRAY MOSQUERA • 732-979-3888 • RMOSQUERA@KOEPPELAUTOGROUP.COMSAGAR PATEL • 347-533-1588 • SPATEL@KOEPPELAUTOGROUP.COMSAIFUL ISLAM (GSM) • 646-267-6705 • SAIFUL@KOEPPELAUTOGROUP.COMZIA DIN •646-591-3932 • ZDIN@KOEPPELAUTOGROUP.COM Finance Manager * DANTE MORRISON • 862-832-0139 • DMORRISON@KOEPPELAUTOGROUP.COMSTEVE KONTONICOLAOU • 718-813-3822 • STEVEK@KOEPPELAUTOGROUP.COM First Name * Middle Name Last Name * Suffix Customer Phone * 1 License Image? * Yes No Front of License * Drop a file here or click to upload Choose File Maximum file size: 134.22MB Address * City * State * CTNJNY Zip * Date of Birth * Phone (Cell) * Company Name CURRENT INSURANCE INFORMATION Current Insurance Image? * Yes No Insurance Card * Drop a file here or click to upload Choose File Maximum file size: 134.22MB Current Insurance Company * AllstateGeicoLiberty MututalState FarmNationwideProgressiveFarmersTravelersUSAANYCMBroker-Don't know Agency Phone Policy Number * NEW VEHICLE INFORMATION Window Sticker Image? * Yes No Window Sticker Image * Drop a file here or click to upload Choose File Maximum file size: 134.22MB New Vehicle Year * 20142015201620172018201920202021202220232024202520262027202820292030 New Vehicle Make * MazdaOther New Vehicle Make New Vehicle Model * New Vehicle VIN * New or Used Vehicle? * New Used Used Vehicle Mileage * MSRP * $ FINANCING INFORMATION Finance or Lease? * Finance Lease Cash Financing Company? * ALLY FINANCIAL • PO BOX 8138 • COCKEYSVILLE, MD 21030AMERICAN BROADCAST EMPLOYEES FCU • 7-11 FRONT STREET • ROCKVILLE CENTER, NY 11570AMERICREDIT FINANCIAL SERVICES INC • PO BOX 182673 • ARLINGTON, TX 76096AUDI FINANCIAL SERVICES • 1401 FRANKLIN BLVD • LIBERTYVILLE, IL 60048BANK OF AMERICA NA • PO BOX 2759 • JACKSONVILLE, FL 32203BETHPAGE FEDERAL CREDIT UNION • PO BOX 6612 • GREENWOOD VILLAGE, CO 80155CAPITAL ONE AUTO FINANCE • PO BOX 660068 • SACRAMENTO, CA 95866CREDIT ACCEPTANCE CORP • PO BOX 513 • SOUTHFIELD, MI 48037EXETER FINANCE LLC • PO BOX 166008 • IRVING, TX 75016FORD MOTOR CREDIT COMPANY • PO BOX 105704 • ATLANTA, GA 30348GATEWAY ONE LENDING AND FINANCE • PO BOX 269133 • SACRAMENTO, CA 95826ISLAND FCU • 120 MOTOR PARKWAY • HAUPPAUGE, NY 11788-5160J P MORGAN CHASE BANK NA (Lease) • PO BOX 901033 • FORT WORTH, TX 76101J P MORGAN CHASE BANK NA (Retail) • PO BOX 901033 • FORT WORTH, TX 76101KEYBANK, NA • PO BOX 676 • WILMINGTON, OH 45177M&T BANK • PO BOX 997517 • SACRAMENTO, CA 95899MUNICIPAL CREDIT UNION • 22 CORTLAND ST • NEW YORK, NY 10007NASSAU EDUCATORS FCU • 1000 CORPORATE DR • WESTBURY, NY 11590NASSAU EDUCATORS FCU • PO BOX 324302 • FORT WORTH, TX 76124NASSAU FINANCIAL FCU, LOAN PROCESSING DEPT • 865 MERRICK AVENUE, SUITE 250N • WESTBURY, NY 11590NISSAN INFINITI LT (NILT INC TRUSTEE) • PO BOX 254648 • SACRAMENTO, CA 95865NISSAN MOTOR ACCEPTANCE CORP • PO BOX 254648 • SACRAMENTO, CA 95865OCEAN FINANCIAL FCU • 45 ATLANTIC AVENUE • OCEANSIDE, NY 11572PEOPLE’S ALLIANCE FCU • 125 WIRELESS BLVD • HAUPPAUGE, NY 11788SANTANDER CONSUMER USA • PO BOX 961288 • FT WORTH, TX 76161TFCU • PO BOX 9005 • SMITHTOWN, NY 11787TD AUTO FINANCE LLC • PO BOX 675. WILMINGTON, OH 45177 LIEN CODE: 64477TEACHERS FCU • PO BOX 924182 • FT WORTH, TX 76124TEACHERS FEDERAL CREDIT UNION • PO BOX 9005 • SMITHTOWN, NY 11787US BANK N/A • PO BOX 3427 • OSHKOSH, WI 54903VALLEY NATIONAL BANK • 1445 VALLEY ROAD • WAYNE, NJ 07470WELLS FARGO DEALER SERVICES • PO BOX 997517 • SACRAMENTO, CA 95899WINTHROP UNIVERSITY HOSPITAL EMPL FCU • 194 FIRST STREET • MINNEOLA, NY 11501 Leasing Company? * TMCC/TLT • PO BOX 105386 • ATLANTA, GA 30348 Is There a Co-Signer? * No Yes Co-Signer (Please type the person's name). REGISTRATION INFORMATION Replacement Vehicle? * Yes No Vehicle Replacing? ADDITIONAL INFORMATION Additional Notes Captcha Submit