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Veritas Select
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Refer a Dealership
Decline VSC eForm
Submit “Second Chance” Lead
Order Materials
Start a Veritas Claim
Cancellation PDFs
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Second Chance Opportunity
Everyone Deserves a Second Chance
"
*
" indicates required fields
Step
1
of
5
20%
Have a customer walk away without a warranty?
Let's see if we can close them for you. We'll send you back $250.00 for each sale we complete.
Tell us about you:
*
First
Last
Dealership
*
Email
*
Phone
*
Your Venmo
*
Tell us about our new prospect
& thank you for the opportunity
Walk Away Customer Info
*
First
Last
Email
*
Cell Phone
*
Purchase Behavior
Vehicle Service Contract Objections
*
Cash Buyer
Couldn't Include in Loan
Cost Objection
Past Experience
Always Rejects these Programs
Other
Select all that apply
Other Objection
Did they purchase ANY aftermarket products?
*
Yes
No
Other Aftermarket Products Purchased
About the Vehicle
Clean or Branded / Rebuilt Title
*
Clean Title
Branded / Rebuilt Title
VIN
*
Odometer
*
Vehicle Condition
*
Like New
Gently Used
Has Mechanical Modifications
Needs Work
Modified or Needs Work
Website Link to Vehicle
Purchase Details
Sale Date
*
Month
Day
Year
Purchase Method
*
Driver Cash Purchase
Driver Financed
Third Party Cash
Third Party Financed
Monthly Payment Amount
Vehicle Purchase Price
*
Third Party Situation
Additional Info
