Problem Auto Claim Consultations Order Form

* Indicates Required Fields

Vehicle Owner Information
Name:	* Required	Home Address:	* Required
Primary Phone:	* Required	City:	* Required
Alternate Phone:		State:	* Required
Cell Phone:		Zip:	* RequiredInvalid format.
Email Address:	* RequiredInvalid format.

Questions / Notes

Problem Auto Claim Consultations Service Agreement

Purpose & Scope: This is an order for our vehicle claim Consultation Services. The fee charged is for a one-time consultation. Each further consultation will be a separate charge. I certify and understand that Collision Claim Associates, Inc., it agents, representatives and appraisers are not engaged in the practice of law. That none of the information contained in the website www.collisionclaims.com, nor any of the information obtained during any verbal conversation is meant to be or offered as legal advice. The services and reports offered are limited to that of vehicle appraisal and the purposes for which those services might be used. All reports and documents available for purchase, are sold on an as is basis and represent the opinions and conclusions of Collision Claim Associates, Inc. and its appraisers. There is no warrantee written or expressed as to the purpose or intended use of the reports or documentation provided.
RequiredI have read and fully understand both the Service Agreement & the website Terms Of Use