RV Value Mart Buyers Order Form

* Required

Purchaser Information

What salesperson are you working with?

First Name *

Middle Initial *

Last Name *

Social Security No. *

(xxx-xx-xxxx)

Date of Birth *

(mm/dd/yyyy)

Email *

Phone *

Marital Status *

Credit Card Information

Card Type *

Card Number *

Name on Card *

Card Expiration Date *

(mm/yy)

Card Security Code *

Card Billing Address *

How much will your deposit be? *

(ex $2000, $3000, etc)

Acknowledgement

* By checking this box you promise that all information is true and complete. In the event of any failure by the Purchaser to perform the Purchaser's obligations including but not limited to, any failure to take delivery of or to pay the agreed purchase price of the ordered motor vehicle, the Dealer shall be permitted to retain any amount previously paid by the Purchaser as liquidated damages for the Purchaser's default.

It's ok to contact me about future discounts and events.

(Easily unsubscribe at any time.)

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