LOUISIANA DEPARTMENT OF PUBLIC SAFETY OFFICE OF MOTOR VEHICLES

CONSIGNMENT OF MOTOR VEHICLE CONSIGNORS NAME AND ADDRESS _____________________________________ _____________________________________ _____________________________________
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DEALERS NAME AND ADDRESS ___________________________________ ___________________________________ ___________________________________

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CONSIGNOR

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I, ___________________________________________, hereby agree and consign the following motor vehicle: YEAR BODY STYLE MAKE LICENSE NO. MOTOR NO.

which motor vehicle is licensed in the state of Louisiana through 20_______, and has an odometer reading of _______________, to _______________________________, hereinafter referred to as agent, for a term of _____________ days commencing on the ____________ day of ___________________, 20 ________. I agree that an inspection of the vehicle by the agent produced the

following defects being noted as existing at the time the vehicle was placed with the agent:
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________________________________________________________________________________________________________ By the terms of this consignment contract, I agree that at the consummation of the sale, I shall pay to consignee a commission fee based on a percentage of the sales price of the motor vehicle as set forth below: SALES PRICE COMMISSION In addition, in consideration of consignee placing the above captioned vehicle on its sales lot, I agree to pay the consignee a nonrefundable consignment fee of $_______________, upon delivery of said vehicle to consignee. I agree that this consignment fee is nonrefundable whether the consignment agreement reaches the desired result of a sale of the motor vehicle or not. I understand that I shall not receive a credit in the amount of this consignment fee on the commission due to the consignee in the event this agreement produces the desired result of a sale of the motor vehicle. I, as consignor, warrant to the consignee and purchaser that I will deliver a merchantable title which is free of any and all mortgages, liens, or debts encumbering the vehicle at the time of the act of sale. The minimum acceptable sale price for the above captioned vehicle is $_______________________________________ The captioned motor vehicle is free and clear of all mortgages, liens and debts except for: OWED TO (Holder of Indebtedness) AMOUNT OWED DESCRIPTION OF INDEBTEDNESS $ as of the ____________________ day of _____________, 20 __________, I as consignor agree to fully liquidate said debt prior to or simultaneously with the execution of an act of sale on said vehicle. I agree to deliver a clear title and certificate of registration to agent in accordance with any pertinent laws and/or regulations governing the sale of a motor vehicle in the State of Louisiana. I, as consignor, agree that ______________________ nor any owner, agent or employee thereof is not liable for theft, vandalism or damages of any kind or nature whatsoever which might occur to said motor vehicle while in its possession. I further agree that ________________________ may allow prospective purchasers of the vehicle to test drive the vehicle. I, as consignor, agree to provide a certificate of insurance guaranteeing maintenance of liability insurance in the minimum amounts of $5000/$10,000/$5000 and to maintain collision coverage on the motor vehicle while it is in the agents possession. I, as consignor, agree that in the event _________________________________ elects to accept a trade-in as part of the agreed sales price of the consigned vehicle, to sell said vehicle to ____________________________________ for a price not more nor less than the agreed upon minimum sales price less the specified commission per this contract. I, as consignor, agree that ______________________________ has no ownership in the said motor vehicle, unless purchased as described in the preceding paragraph, and will make no warranty of any kind or of any nature with respect to the motor vehicle to purchaser. I also agree to hold __________________________________ free and harmless from any liability, cost or attorney fees involved in any action in warranty brought against them. WITNESS CONSIGNOR WITNESS NOTARYS SIGNATURE CONSIGNEE (President) NOTARYS PRINTED NAME/NUMBER

I, as consignee, hereby warrant title to any purchaser of said vehicle free of all mortgages, liens and debts. I, as consignor, agree to accept the above mentioned minimum sales price of $__________________ less the designated commission owed to ____________________________________ for my motor vehicle per this contract. WITNESS WITNESS NOTARYS SIGNATURE DPSMV 1990 (04/09) CONSIGNOR DATE NOTARYS PRINTED NAME/NUMBER