Vehicle Information Request Form
Are you interested in a new or used vehicle?
New
Used
Select Vehicle -- By Type
or
By Specific Make/Model
By Type
General Vehicle Type
Choose One:
Convertible
Coupe/Hatchback
Minivan/Van
Sedan
SUV
Truck
Wagon
Year/Year Range
Price Range
Choose One:
Under $10K
$10K - $15K
$15K - $20K
$20K - $25K
$25K - $30K
$30K - $35K
$35K - $40K
Above $40K
or
By Specific Make/Model
Make
Model
Year/Year Range
Exterior Color
Interior Color
Transmission
Choose One:
Automatic
Manual
No Preference
Engine Preference
Choose One:
4 Cylinder
6 Cylinder
8 Cylinder
Other
No Preference
Desired Options
When do you plan to buy?
Choose One:
Immediately
Less than 1 mo.
1 - 3 months
3 - 6 months
Do you plan to trade in a vehicle?
Yes
No
If yes, please complete:
Make
Model
Year
Mileage
Condition
Choose One:
Outstanding
Clean
Average
Rough
Contact Information
First Name*
Last Name*
Daytime Phone*
Address
City
State
Zip
E-mail Address*
Preferred method of contact: Phone
Email
*These fields are required
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Mid American Credit Union
- 8404 West Kellogg Drive, Wichita, Kansas 67209 - (316) 722-3921 * Fax (316) 722-0920 -
macu@midamerican.coop