Total Loss Vehicle Appraisal Order Form

Post Repair Vehicle Inspection 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.

Vehicle Inspection Location
Please provide us with the location where your vehicle can be inspected. Inspections are completed Monday – Friday between the hours of 8:00am and 5:00pm. Specific times are not given due to the uncertainty of traffic and other delays. You may select a day part.
Preferred Day Part:	8:00am – 12:30pm 12:30pm – 5:00pm	Location:	Residence Address As Above Work Other
Name of Location:		Street Address:
Phone Number:		City:
Contact Name:		State:
		Zip:

Vehicle Information
Year:	* Required	Make:	* Required
Model:	* Required	Color:
Series/Package: (i.e.: LS, ES, XLT, GL)		Number of Doors:
VIN Number:	* Required
Engine Size:		# Of Cylinders:
Engine Type:	Gas Diesel Hybrid Turbo	Transmission:	Automatic Manual Speed
Mileage at time of Damage:	* Required	Pre-Damage Vehicle Condition:	* Required
Any Prior Collision?
(If Yes) Give Date
Cost of Repairs $

Notes

Total Loss Vehicle Appraisal Service Agreement

Purpose & Scope: This is an order for our post-repair vehicle inspection services. We will provide an inspection report including photographs of the vehicle. 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