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Odometer Disclosure Form

When selling a car to another person, you need to use a document like the one found below to declare the authenticity of the odometer reading.

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Odometer Template

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Odometer Disclosure Form

Effective Date: ____/____/______

Buyer [Legal Name] (AKA, “The Buyer”)

Located [City], [State] [Zip Code]


Seller [Legal Name](AKA, “The Seller”)

Located at [Address]

[City], [State] [Zip Code]

I the Seller do hereby state that the odometer mileage as indicated for the below described vehicle is in the following:

[__] Miles [__] Kilometers [__] Hours

To the best of my knowledge, I do hereby certify that:

[__] The odometer reading is the actual logged mileage.

[__] The odometer reading is an amount of mileage that is beyond its mechanical limits.

[__] The odometer reading is not the actual mileage that has been used.

Year: ____________________________________________________

Make: ____________________________________________________

Model: ___________________________________________________

Body Type: _______________________________________________

VIN: _____________________________________________________

Applicable Law

This contract shall be governed by the laws of the State of __________ in __________ County and any applicable Federal Law.

Signature of The Buyer

Signature of The Seller

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