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2. First Name*
3. Middle Initial*
4. Last Name*
6. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Phone Number*
14. Cell Phone Number
15. Email address
17. Type of Trailer*
    -- Select One --Cattle Pot TrailerDump TrailerEnclosed TrailerFlatbed TrailerGrain TrailerHorse TrailerLivestock TrailerTanker TrailerUtility Trailer
18. Year*
19. Length*
20. # of axles*
22. Make*
23. Model
24. VIN #*
26. Gooseneck or Bumper Pull*
    -- Select One --Bumper PullGooseneck
27. # of Horses
28. # of Gallons
30. Date of Purchase*
31. Purchase Price*
32. New or Used*
    -- Select One --NewUsed
34. Name & Address of whom you purchased the trailer from?*
36. Is the Trailer used for Business*
    -- Select One --YesNo
37. Is it State Assessed
    -- Select One --YesNo
39. What is the business name & address?
41. Is the trailer used for farming?*
    -- Select One --YesNo
42. (A picture must be submitted before farm exemption will be considered)
44. What name is the trailer being titled and registered under?*
46. What address will the property be located at?*
48. Submit a Picture, Bill-of-Sale or Invoice
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50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit Submit and Print

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