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Get VA LES 022A 2003-2024

ER THAN ABOVE CONTACT NAME TELEPHONE NUMBER ( ZIP CODE ) REBUILDER: ALL INFORMATION BELOW MUST BE COMPLETED PRIOR TO EXAMINATION MAKE YEAR COLOR TOP/BOTTOM MODEL VIN (VEHICLE IDENTIFICATION NUMBER) VIRGINIA SALVAGE CERTIFICATE NUMBER NOTE: $25.00 FEE IS REQUIRED TO EXAMINE ALL SALVAGE VEHICLES. DESCRIPTION OF REPAIR CUSTOMER NOTES: CIRCLE NUMBER TO INDICATE REPAIR AREA (21) (List Other Parts - Explain) RE BU IL D ER: P le a se c he c k t he p a rt s rep l ac ed o r r ep ai r ed.

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