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2. Please fill out the information for your Request. You will need to enter your address and the vehicle information fields. Many fields are required as they are needed for property tax and sales tax calculations. Fields left blank may affect your quote.
   
   We will normally get you a response within one business day of receipt of your request. Responses after 4:30 p.m, on weekends or holidays may take additional time.
6. Customer Information
8. First Name*
9. Last Name*
11. Phone*
12. Email*
14. Address*
16. City*
17. State*
18. Zip Code*
22. Vehicle Information
24. Vehicle Year*
25. Vehicle Identification Number*
27. Make*
28. Model*
29. Body Style*
31. Purchase, Renewal or Move-In
    -- Select One --Move InPurchaseRenewal
32. Sale Price
33. Date of Purchase
    Date of Purchase
35. Are you moving from Out of State or Out of County
    -- Select One --Out of StateOut of County

    Moving from Out of County means you are moving from within Nebraska, but outside of Lancaster County.

37. Is this Vehicle a Truck or Trailer?*

    1. Yes
    2. No
38. What tonnage or weight will vehicle be registered for?
40. Trade In
    -- Select One --NoYes
41. Trade in Value Received
42. License Plate Number of Trade-In
44. Dealer Rebate
    -- Select One --NoYes
45. Amount of Rebate
46. Does the Vehicle Have a Lien
    -- Select One --No Yes
48. Active Duty Non-Resident Military
    -- Select One --NoYes
49. State of Legal Residence
51. Other Vehicle Notes
53. Disclaimer
    A quote is an estimation only of the costs to title and register your vehicle based on the information provided; your actual costs may vary slightly based on the reported Manufacturer Suggested Retail Price, options, warranties or special equipment.
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field