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This form covers the required documentation fields for catalytic converter purchases in most states. Adapt for your state's specific requirements — some require additional fields such as seller thumbprint or vehicle photograph. Complete one form per transaction and retain for the required period.
Print This Form
Ctrl+P or Cmd+P → Save as PDF. One form per transaction.
CATALYTIC CONVERTER PURCHASE RECORD
Complete all fields. Retain minimum 2 years (3 years in GA, VA).
Date
___________________
___________________
Time
___________________
___________________
Employee Processing Transaction
_________________________________
_________________________________
SELLER INFORMATION
Full Legal Name (exactly as on ID)
_________________________________
_________________________________
Current Residential Address
_________________________________
_________________________________
Date of Birth
_______________
_______________
ID Type
□ DL □ State ID □ Passport
□ DL □ State ID □ Passport
ID Number
___________________
___________________
SOURCE VEHICLE
Vehicle VIN (17 characters)
_________________________________
_________________________________
Year
_______
_______
Make
_______
_______
Model
_______
_______
Ownership Proof
□ Title □ Registration □ Other: ____
□ Title □ Registration □ Other: ____
Seller Signature (vehicle is mine)
_______________________
_______________________
TRANSACTION
Quantity
___________
___________
Weight
___________
___________
Amount
$_________
$_________
Payment Method
□ Check # _________ □ ACH/EFT
□ Check # _________ □ ACH/EFT
Payment Release Date (after hold)
___________________
___________________
Photos Taken
□ Seller □ Converter □ Vehicle
□ Seller □ Converter □ Vehicle
Electronic Report Submitted
□ Yes — System: _______ □ N/A
□ Yes — System: _______ □ N/A
Retain for minimum 2 years. ScrapDealerGuide.pages.dev — Free to copy and use.
This template is a general reference. Adapt to your state's specific requirements. Not legal advice.
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