Problem Auto Claim Consultations Order Form

* Indicates Required Fields

Name*
Email Address*
Primary Phone*
Alternate Phone
Cell Phone*
Home Address*
Street Address City State ZIP Code
Questions / Notes
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.
Problem Claim Consultation $35.00*
Price:
Coupon
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Terms Agreement*
- I have read and fully understand both the Service Agreement & the website Terms Of Use
Terms of Use