Annual Purchasers Certification
of Export-Only Sale
Period January
to December
This form may only be used with automated export-only sales reports for salvage or nonrepairable motor
In accordance with Texas Transportation Code, §501.099,
you may only purchase a salvage or nonrepairable
motor vehicle from a licensed dealer or a governmental entity for export if you are not a resident of the
United States. The seller must obtain a legible copy of your government issued photo identification (ID)
issued by a jurisdiction where you reside.
Please complete all fields of this form unless otherwise noted. Record the type of photo ID (i.e. passport,
driver license, ID card), the jurisdiction that issued the photo ID, and the photo ID number.
Seller Information
Dealer or Government Agency Name Dealer License Number (if applicable)
Purchaser Information
Middle Name
Last Name
Suffix (if any)
Type of Government Issued Photo ID
Jurisdiction that Issued the Photo ID
Photo ID Number
Country Postal Code
Purchaser Certification - State law makes falsifying information a third degree felony
I, the purchaser listed above, certify in accordance with Texas Transportation Code, §501.099, that I will remove the motor
vehicle(s) described above from the United States, not return the motor vehicle(s) to any state of the United States as a motor
vehicle titled or registered under its manufacturer’s vehicle identification number, and not operate or permit the operation of the
motor vehicle(s) on a public highway.
Signature of Purchaser
Printed Name (Same as Signature)
VTR-901-A Rev 05/20 Form available online at Page 1 of 1