COVER SHEET FOR DUPLICATE MCO REQUEST (To be submitted with application) LINDA KPORWODU VOLKSWAGEN ACCOUNTING SERVICES 777 BAYLY ST. WEST AJAX, ONTARIO, CANADA L1S 7G7 Phone # (905) 428-5849 Fax # (905) 428-5834 [email protected] DATE_____________________ # OF PAGES:_______________ DEALER NAME: ________________________________________________________ VW/AUDI/BENTLEY DEALER NUMBER__________________________________ REQUESTOR’S TELEPHONE NUMBER:_______________________EXT. #:_____ REQUESTOR’S NAME: __________________________________________________ PLEASE PRINT NAME REQUESTOR’S EMAIL ADDRESS: ________________________________________________________ SEND MCO BY: FEDERAL EXPRESS: #_____________________________________ UPS Account Number: #_____________________________________ REGULAR MAIL (allow 10-15 business days for delivery) IF REQUEST IS REGARDING A VEHICLE WHO’S ORIGINAL DEALER IS ONE OF THE FOLLOWING (MILITARY SALES, LEASE PLAN/FLEETOR COURTESY DELIVERY / BUYBACK), PLEASE CONTACT A REPRESENTATIVE FROM EACH RESPECTIVE AREA. FAILURE TO INCLUDE YOUR FED-EX/UPS ACCOUNT NUMBER, WILL AUTOMATICALLY GUARANTEE THAT THE REPLACEMENT MCO WILL BE SENT BY REGULAR MAIL. INSTRUCTIONS: PLEASE COMPLETE THE ATTACHED APPLICATION, FAX A COPY TO US AND SEND THE NOTARIZED ORIGINALS BY REGULAR MAIL TO THE ADDRESS ABOVE. This form is also available at: http://vw.invoicecopy.com APPLICATION FOR DUPLICATE MANUFACTURER’S CERTIFICATE OF ORIGIN TO A MOTOR VEHICLE The undersigned (“Applicant”) hereby applies to Volkswagen of America, Inc. (“VWoA”) for a duplicate of the “Manufacturer’s Certificate of Origin to a Motor Vehicle” (“MCO”) for the vehicle described below (the “Vehicle”): Make ___________________ Year _____________ Model _____________ Vehicle Identification Number _______________________________________ LIEN INFORMATION If no lien, check this box: To Whom Due: Address: _____________ ______________________ Applicant represents and warrants: 1. Applicant is the lawful owner or lienholder of the motor vehicle; 2. The original MCO has never been assigned by Applicant; and 3. The original MCO has been lost, destroyed or not received 4. Other, please specify: ______________________________________ Applicant will indemnify, defend and hold harmless VWoA from and against any and all claims, demands and costs arising out of VWoA’s issuance of a duplicate MCO. Dated: __________________ Name of Corporation (if applicable): ______________________________________ By: ___________________________________ Print Name: ____________________________ Title: __________________________________ State of _________________________) ) County of _______________________) Subscribed and sworn to before me this _____ day of ______________ 20 _____. ___________________________ Notary Public My Commission Expires: _______