Download - VVSi Valuation Request Forms Truck/Tractor Standard Auto ... · Truck/Tractor Valuation Request Form. Office ID Number: Company: Claim Rep Name: Email: Phone / Fax: Calculate Sales

VVSi Valuation Request Forms

Truck/Tractor

Commercial/Utility Trailer

Construction/Agriculture Equipment

Standard Auto

SUV/TRUCK/VAN

Specialty Auto

RV/Travel Trailer

Large Marine

Small Marine

Motorcycle

Snowmobile

Manufactured Housing

Personal Watercraft

Diminished Value

Truck/TractorValuation Request Form

Office ID Number: Company:Claim Rep Name: Email:Phone / Fax: Calculate Sales Tax: Yes No Car Fax Requested: Yes NoLicense Fee Amount: Deductible:Salvage Value: Salvage Bid Requested: Yes No Claim Ref #:Type Of Loss: Date Of Loss:

Owner / Insured: Insured Phone / Contact:City / State / Zip:Appraiser Company: Appraiser Name:Appraiser Phone / Email: Appraisal Amount: ACV Amount:

Year: Make: Model:

Tractor Cab And Chassis Van Flat Bed Stake Refrigerated Dump Wrecker Rollback

Style (Circle One): Interstate Intrastate Innercity Body Info:

Engine Make / Model / HP: Trans Make / Model / Speeds: Two Speed Rea Yes No

# Of Axles: # Of Drive Axles: # Of Tag Axles: Front Axle Rating Rear Axle Rating

GVW: Wheel Base: Odometer: Previous Salvage/Branded Title: Yes No

Conv Sleeper Size Front Tire Size

COE Sleeper Size Rear Tire Size

Flat Top Skyrise Unibilt Suspension (circle one)Mid Roof Condo Ultra Spring High Rise Aerocab Air Ride

Interior Trim Hendrickson

AM/FM/ST CA Torsion Bar

CD MP3 Lift Gate Yes No

NAV Lift Gate CapacityAir Ride Cab Yes No Fuel Tank TypeAir Conditioning Yes No # Of Fuel Tanks SizeSRS Air Bags Yes No Fixed Manual Slide Front Tire Wear Remaining

Air Slide None

APU Yes No PTO Yes No %

Front Wheel Type (circle one): Wet Line Kit Yes NoAir Brakes Yes No Rear Tire Wear RemainingEngine Brake Yes No

Outside Rear Wheel (circle one): %Side Fairings Yes NoWind Deflector Yes No Other Items

Inside Rear Wheel (circle one): Full Aero Yes No

Refurbishments Date/Cost Prior Damage Description Amount

Interior

Exterior

Condition Ratings: 1 = Excellent 2 = Above Average 3 = Average 4 = Below Average 5 = Poor PLEASE SEND PHOTOS IF AVAILABLE

Spoke (Dayton) Steel Disc (Budd) Aluminum

Interior

Exterior

VIN:

Transmission

Aerodynamics

Radio (Circle All That Apply):

Exterior5th Wheel Type

(Circle One):

1.888.475.9975 Phone

1.888.475.9935 Fax

Interior Conditions

[email protected]

Body Style (Circle One):

Options



1 2 3 4 5

1 2 3 4 5

1 2 3 4 5 1 2 3 4 5

Sleeper Style: Body

PaintGlass

1 2 3 4 5

1 2 3 4 5

Tires

DrivetrainEngine

Commercial TrailerValuation Request Form

Office ID Number: Company:Claim Rep Name: Email:Phone / Fax: Calculate Sales Tax: Yes No Car Fax Requested: Yes NoLicense Fee Amount: Deductible:Salvage Value: Salvage Bid Requested: Yes No Claim Ref #:

Type Of Loss: Date Of Loss:Owner / Insured: Insured Phone / Contact:City / State / Zip:Appraiser Company: Appraiser Name:Appraiser Phone / Email: Appraisal Amount: ACV Amount:

Year: Make: Model:

Dry Van Refrigerated Van Flat Bed Low Boy Tanker Enclosed

Utility Furniture Car Hauler Dump Landscape OtherExterior (Circle One): Aluminum Steel Stainless Steel # of Axles: Length

Previous Salvage/Branded Title: Yes No

Height Cooling Unit Year

Width Cooling Unit Mfg 1 2 3 4 5

Sliding Axle Yes No Cooling Unit Model

Suspension: Spring Air Ride Torsion Other Cooling Unit Hours 1 2 3 4 5

GVW CARB Compliant Yes No 1 2 3 4 5

ABS Yes No Refrigerated Commodity

Interior Lining 1 2 3 4 5

Insulated Yes No Tank Size 1 2 3 4 5

Rear Door Type Compartments

Side Door Yes No Baffled Yes No

Outside Wheel Type: Spoke Steel Aluminum Pump System Yes No

Inside Wheel Type: Spoke Steel Aluminum Heated Yes No Front Tire Wear Remaining %

Tire Size Commodity Carried

Liftgate Capacity Tank Code Rear Tire Wear Remaining %

Liftgate Type: Electric Hydraulic Other Other Items:

Spread Axle Yes No

Aero Skirts Yes No

Tarp: Electric Manual

Refurbishments Date/Cost Prior Damage Description AmountCondition Ratings: 1 = Excellent 2 = Above Average 3 = Average 4 = Below Average 5 = Poor PLEASE SEND PHOTOS IF AVAILABLE

Cooling Unit

1.888.475.9975 Phone

1.888.475.9935 Fax

Conditions

Interior

Mechanical

Lining

Body

Paint

HydraulicsTank Trailers Only

Refrigerated Trailers

[email protected]

Type (Circle One):

Options

Tires

VIN:

Exterior

Trailer Components

EquipmentValuation Request Form



Year: Make: Model:

Industrial Farm Other: Hours:

Engine Manufacturer: Engine Model/Horsepower

Transmission Manufacturer: Transmission Model/Speeds

Number of Axles: Number of Drive Axles: Previous Salvage/Branded Title: Yes No

EROPS Yes No Other Items:

Air Conditioning Yes NoOROPS Yes No 1 2 3 4 5

Air Cond. 1 2 3 4 5 Tire Size 1 2 3 4 5

Ply Rating 1 2 3 4 5 1 2 3 4 5

Track WidthOverhaul Type (Circle One): 1 2 3 4 5

Pad Size 1 2 3 4 5 1 2 3 4 5

Bucket Type Hours Since:

Date Front Tire Wear Remaining %

Bucket Size Cost Rear Tire Wear Remaining %

Backhoe Dipper Size

Undercarriage Wear Rem. %

Backhoe Bucket Size Pads %

Tracks %

Aux. Hydraulics



Yes No

PaintDrivetrain

Tires

Undercarriage

HydraulicsIn Frame Out Of Frame

Engine

Transmission

[email protected]

Type (Circle One):

1.888.475.9975 Phone

1.888.475.9935 Fax

PIN:

Body

Options & Equipment

Conditions

Interior

Exterior

SeatsGlassDash

Private Passenger VehicleValuation Request Form



Year: Make: Model:

Body Style: Engine: Transmission:

4WD: Yes No AWD: Yes No Mileage: Previous Salvage/Branded Title: Yes No

Power Windows Yes No Cloth Cloth/Leather

Power Locks Yes No Leather Velour Vinyl

Power Driver Seat Yes No Spoke Steel Aluminum

Power Passenger Seat Yes No Wheel Covers Chrome

Roof Type

Rear Wipers Yes NoHeadlight Washer Yes No Spoiler Yes NoHeated Mirrors Yes NoTowing Equipment Yes No

Theft Deterrent Yes NoA/C Yes No Disc Brakes:

Telescopic Wheel Yes No ABS:

AM/FM/ST CA Driver

CD MP3 Driver/Passenger

NAV AUX Driver/Passenger/Front Front Tire Wear Remaining %

Driver/Passenger/Front/Rear

Fog Lights Yes No Rear Tire Wear Remaining %

Keyless Entry Yes NoHeated Seats Yes No Other Items:

Tinted Glass Yes No



1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Safety Equipment Glass

Paint

Body

Convenience Options

Audio and Nav System (Circle All

That Apply):

Conditions

Other Equipment

Interior

Exterior

Headliner

Carpet

Dash

Seats 1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Interior Trim (Circle One)

Wheel Type

Transmission

Engine

Air Bags:

1 2 3 4 5

Drivetrain

Tires

[email protected]

Options

1.888.475.9975 Phone

Power Options

1.888.475.9935 Fax

Décor Equipment

Premium Sound

Front 4 Wheel None

2 Wheel 4 Wheel None

VIN:

SUV-Truck-VanValuation Request Form



Year: Make: Model: Previous Salvage/Branded Title: Yes No

Minivan Compact SUV Mid-Size SUV Full-Size SUVCompact Pick-Up Full-Size Pick-Up Conversion Van (Handicap) Conversion Truck

Engine: Trans: 4WD: Yes No AWD: Yes No Mileage:

Captain's Chairs Yes NoPower Windows Yes No Theft Deterrent Yes No Extended Yes NoPower Locks Yes No Air Bags: Driver Central Vacuum Yes NoPower Driver Seat Yes No Driver/Passenger Ice Box Yes NoPower Passenger Seat Yes No Driver/Passenger/Front Side Microwave Yes No

Yes No Driver/Passenger/Front/Rear Power Sofa Bed Yes NoPower Trunk Yes No Radar Detector Yes No

Disc Brakes: Front 4 Wheel None Solar Panels Yes NoA/C Yes No Step Bumper Yes No Porta Potty Yes NoRear Air Yes No ABS:Telescopic Wheel Yes No Running Boards Yes No Wheelchair Lift Yes NoCruise Control Yes No Roll Bar Yes No Tie Downs Yes No

AM/FM/ST CA Grill Guard Yes No Hand Controls Yes NoCD MP3 Sliding Rear Window Yes No Remote Entry Yes NoNAV Bed Liner Yes NoCD Player No Chrome Bed Rails Yes NoCD Changer _______ Disc Permanent Tool Box Yes No

Heated Seats Yes No Passenger Seating:Tinted Glass Yes No Third Door Yes NoHeated Mirrors Yes No Power Sliding Door Yes NoTowing Equipment Yes No Driver Side Door Yes No

Entertainment System Yes NoInterior Trim Cloth Cloth/Leather Dual Rear Wheels Yes No

Leather Velour Aux Fuel Tank Yes No

Vinyl

Wheel Type Conversion Mfg:Third Seat Yes No Conversion Model:Roof Type Raised Roof Yes NoSpoiler Dual Radio Yes No

TV Yes No Front Tire Wear Remaining %DVD Yes NoGaming System Yes No Rear Tire Wear Remaining %



Décor Equipment

ConditionsInterior

1 2 3 4 5

1 2 3 4 5

Handicapped Vehicles Only

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5 1 2 3 4 5

Exterior

1 2 3 4 5

1 2 3 4 5

CarpetHeadliner

BodyPaintGlass

Drivetrain

1.888.475.9975 Phone

Power Antenna

Power Options

Convenience Options

Engine

TiresTransmission

SeatsDash

1.888.475.9935 Fax


Compact Disc:

Safety Equipment

1 2 3 4 5

[email protected]

Body Style (Circle One):

Options


Truck/SUV Options

VIN:

Conversion Options

Specialty VehicleValuation Request Form



Year: Make: Model:

Body Style: Engine: Cylinders: Cubic inch/Liters: 4WD/AWD:Transmission: Overdrive: Package (If Applicable):

Power Windows Yes No Theft Deterrent Yes No Dual Axle Yes NoPower Locks Yes No Disc Brakes: Front 4 Wheel None SunroofPower Driver Seat Yes No ABS: Electric Wet Bar Yes NoPower Passenger Seat Yes No Air Bags: Driver Extended Doors Yes No

Yes No Driver/Passenger Intercom Yes NoPower Trunk Yes No Driver/Passenger/Front Side Jacuzzi Yes No

Driver/Passenger/Front/Rear Widebody Yes NoA/C Yes No Fog Lights Yes NoCruise Control Yes No

AM/FM/ST CA 2 Way Radio Yes NoCD MP3 Divider Yes NoNAV Dual Spot Light Yes No

Gun Rack Yes NoLight Bar Yes No

CD Player No Siren Yes NoCD Changer _______ Disc Spot Light Yes No

Heated Seats Yes No Flashers Yes NoHeadlight Washers Yes NoTinted Glass Yes No Limousine ConversionHeated Mirrors Yes No Limousine Conversion ModelTowing Equipment Yes No Stretch Length

Partition Yes NoInterior Trim Cloth Cloth/Leather DVD Yes No Front Tire Wear Remaining %

Leather Velour AM/FM/ST CAVinyl CD MP3 Rear Tire Wear Remaining %

Wheel Type NAVFactory Wheels Yes No Rear Prm Sound Other Items:Third Seat Yes No CD Player NoRoof Type CD Changer ______DiscSpoiler Yes No Dual A/C Yes No



1 2 3 4 5

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

1 2 3 4 5

Yes No

1 2 3 4 5 1 2 3 4 5

1 2 3 4 5

[email protected]

Options

1.888.475.9975 Phone

Power Mirrors

Power Options

1.888.475.9935 Fax

Mileage:

Limousine Options

VIN:

Rear Radio (Circle All That Apply)

Décor Equipment

Police & Taxi Options

Limousine Options

Yes No


Premium Sound

Safety Equipment

Convenience Options

Compact Disc:


Rear Comp Disc:

ConditionsInterior

Exterior

Drivetrain

Tires

SeatsDash

CarpetHeadliner

BodyPaintGlass

EngineTransmission

Recreational VehicleValuation Request Form



Year: Make: Model:

Length: Class: Previous Salvage/Branded Title: Yes No

5th Wheel Trailer Bumper Pull Camper Van Folding Camper Mini Motor

Motor Coach Pop-Up Camper Toy Hauler Travel Trailer Slide On Camper

Chassis Year Chassis Manufacturer Chassis Model #

Engine Manufacturer Engine Model Transmission Type

Slide Out Rooms Yes No # Of Slide Outs Length Of Slide Outs

Outside Shower Yes NoPower Windows Yes No Cabinetry: LevelersPower Locks Yes No Counter Tops Landing GearPower Drive Seat Yes No Interior Trim Electric Tongue Jack Yes NoPower Pass. Seat Yes No Wheel Type

Power Tongue Jack Yes No Fuel Station Yes NoElectric Step Yes No Towing Equipment Rear Screen Wall Yes NoPower Sofa Bed Yes No Suspension Ramp Screen Room Yes NoPower Shades Yes No Alarm Yes No Air Compressor Yes NoGenerator Flat Screen TV(s) Pressure Washer Yes NoInverter Yes No DVD/Blu Ray

Central Vacuum Yes NoDash Air Conditioning Yes No Microwave Yes NoRoof Mount/Aux. A/C Yes No Solar Panels # Watts# of Aux. A/C's Storage Pod Yes NoFurnace BTU Satellite DishGas Electric Luggage Rack LadderAqua Hot Yes No Floor Plan

AM/FM/ST CA KitchenCD MP3 Nav Bath

Premium SoundCD Player No AwningsCD Changer _______ Disc Electric Manual

Dual Radio Yes No # Of Window AwningsCaptain's Chairs Yes No Entry Door Awning Yes No# of Chairs Topper Awning Yes No Front Tire Wear Remaining %Washer And Dryer Yes No Power Yes NoBackup Camera Yes No Rear Tire Wear Remaining %Other ItemsRefurbishments Date/Cost Prior Damage Description Amount


VIN:

Type (Circle One):

OptionsPower Options

1.888.475.9975 Phone

1.888.475.9935 Fax

[email protected]

Cabinetry and Décor Equipment

Toy Hauler

Compact Disc:

Other Equipment

Dash

Convenience Options ConditionsInterior

Seats

CarpetLiving Area

1 2 3 4 51 2 3 4 51 2 3 4 51 2 3 4 5


Awnings

TransmissionTires

ExteriorBodyPaint

DrivetrainEngine

1 2 3 4 5

1 2 3 4 51 2 3 4 5

1 2 3 4 5

Large MarineValuation Request Form



Year: Make: Model:

Length: Hull Material Hours


Generator

Generator KW Trailer Make or Not Inc

Shore Power Trailer Axles

Engine Mfr. Trailer Winch Manual N/A Power

Eng #/HP Seating Capacity Power Tongue Jack

Floor Plan

Cover: Bimini Canvas None

Cabin

A/C 1 2 3 4 5

Number Of Sails Head 1 2 3 4 5

Galley

Halon 1 2 3 4 5

Ice Chest #/Size 1 2 3 4 5

Fish Finder Windlass AncherDepth Finder 1 2 3 4 5

Communications: None Ship-To-Shore VHF Live Well 1 2 3 4 5

GPS Bait Box 1 2 3 4 5

Radar Rod Holders

Plotter/Auto Pilot Outriggers 1 2 3 4 5

Interface Ski Tower

Swing Platform


Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes None

Yes No

Yes No

Engine

Exterior

Paint

Glass

Trailer

Trailer

Hull

Yes No

AM/FM CA CD

MP3 None

Entertainment (Circle All That

Apply):

Sail Type (Circle One): Other None N/A

Nylon Kevlar

Electronics

Fish and Ski Equipment

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Outboard Stern Drive

Engine Type (Circle One):

Propulsion (Circle One):

Aluminum Jet

N/A Stainless Steel

[email protected]

Engine / Propulsion

Interior

Sails

Seats

Carpet

Sail Motor Other

Additional Description

Trailer

Propulsion

1.888.475.9975 Phone

1.888.475.9935 Fax


Conditions

HIN:

Type (Circle One):

Options

None Inboard Jet

Small MarineValuation Request Form



Year: Make: Model:

Length: Hull Material Hours


Seating Capacity Trailer Make or Not Inc

Cover Bimini Canvas None Trailer Axles

Engine Mfr. Cabin Trailer Winch Manual N/A Power

Eng #/HP Head Power Tongue Jack

Halon

Ice Chest #/Size

1 2 3 4 5

1 2 3 4 5

Trolling Thrust 1 2 3 4 5

Live Well 1 2 3 4 5

Bait Box

Number Of Sails Rod Holders 1 2 3 4 5

Outriggers 1 2 3 4 5

Ski Tower 1 2 3 4 5

Swing Platform

Fish Finder 1 2 3 4 5

Depth Finder

Communications: None Ship-To-Shore VHF



Conditions

HIN:

Type (Circle One):

Options

1.888.475.9975 Phone

1.888.475.9935 Fax

Trailer

Trailer

[email protected]

Engine / Propulsion

Interior

Sails

Hull

Seats

Carpet

Sail Motor Other

Additional Description Trailer

Propulsion

Electronics

Fish and Ski Equipment Engine

Exterior

Paint

None Inboard Jet

Outboard Stern Drive

Engine Type (Circle One):

Propulsion (Circle One):

Aluminum Jet

N/A Stainless Steel

Minn Kota Motor Guide

None Yes

Trolling Motor (Circle One):

Sail Type (Circle One):

Nylon Kevlar

Other None N/A

Yes No

Yes No

Yes No

Entertainment (Circle All That

Apply):

AM/FM CA CD

MP3 None

Yes No

Yes None

Yes No

Yes No

Yes No Glass

MotorcyclesValuation Request Form



Year: Make: Model Number:

Model Name: Engine CC Mileage:Touring Performance Cruiser

Enduro ATV Scooter Previous Salvage/Branded Title: Yes No

Fairing: Full Half None Windshield Exhaust Headers Yes No

Travel Trunk Yes No Custom Exhaust Yes No 1 2 3 4 5

Luggage Rack Yes No Custom Paint Yes No 1 2 3 4 5

Back Rest Yes No Performance Tires Yes No

Cruise Control Yes No Custom Wheels Yes No 1 2 3 4 5

Engine Guards Yes No Custom Seat Yes No 1 2 3 4 5

Light Bar Yes No Chrome: Full None Standard

Tow Package Yes No Side Car Yes No

Saddle Bags (Circle One): Front Tire Wear Remaining %

Soft Hard Top Case

Leather None Type Rear Tire Wear Remaining %

Radio (Circle All That Apply): Date

AM/FM CD Cost

Navigation None

Other Items:



[email protected]

Engine

Paint

Body

1.888.475.9975 Phone

1.888.475.9935 Fax

Drivetrain

Custom Accessories Conditions

Exterior

Type (Circle One):

Options

VIN:

Tires

Refurbishments

Transmission

Factory

SnowmobileValuation Request Form

Office ID Number: Company:

Claim Rep Name: Email:

Phone / Fax: Calculate Sales Tax: Yes No Car Fax Requested: Yes No

License Fee Amount: Deductible:

Salvage Value: Salvage Bid Requested: Yes No Claim Ref #:

Type Of Loss: Date Of Loss:

Owner / Insured: Insured Phone / Contact:

City / State / Zip:

Appraiser Company: Appraiser Name:

Appraiser Phone / Email: Appraisal Amount: ACV Amount:

Year: Make:

Arctic Cat John Deere Kawasaki Previous Salvage/Branded Title: Yes No

Polaris Ski-Doo Yamaha

Engine Manufacturer: Engine Size:

Gauges Yes No Mirrors Yes No

Back Rest Yes No Windshield Yes No

Electric Seat Yes No Windshield Bag Yes No

2-Up Seat Yes No Pipes Yes No

Electric Start Yes No Studs Yes No

Hand Warmers Yes No Number Of Studs

Thumb Warmers Yes No Skid Plate Yes No

Belly Cover Yes No

Long Suspension Yes No Ski Skins Yes No

Reverse Yes No Tunnel Protector Yes No

Upgraded Shock Yes No Plastic Skis Yes No



Interior

Mechanical Options

Seats

Dash

Engine

Track

Paint

Glass

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Drivetrain

VIN:

Seat & Dash

Type (Circle One):

OptionsExterior Options Conditions

Exterior

1.888.475.9975 Phone

1.888.475.9935 Fax

[email protected]

Manufactured HousingValuation Request Form



Year: Make: Model:


Washer Yes No

Length Bay Yes No Dryer Yes No

Width Glazed Yes No Water Softener Yes No

Deck Size Thermopane Yes No Wet Bar Yes No

Walkout Yes No Shutters Yes No

Carport Yes No Screens Yes No 1 2 3 4 5

Awning Yes No Storms Yes No

SnkLivingRm Yes No 1 2 3 4 5

Cathedrall Ceiling Yes No # Full

Fireplace Yes No # Half 1 2 3 4 5

Skylights Bedrooms

B. Stereo Yes No 1 2 3 4 5

Furnishing Upgrd Yes No Electric/Gas

Oversize Fridge Yes No

Furnace Yes No Ice Maker Yes No

Central A/C(s) Yes No Freezer Yes No

Window A/C Dishwasher Yes No

Heat Pump Yes No Trash Compactor Yes No

Microwave Yes No

Drywall Yes No Disposal Yes No

Additional Ceiling Yes No

Additional Wall Yes No Other:

Siding Type

Roof Type

Skirting

Anchor System


General WindowsOptions

VIN:

Kitchen

Bathroom

Heat & Air Conditioning

Conditions

Park Rating

Interior

Exterior

Overall

Insulation


1.888.475.9975 Phone

1.888.475.9935 Fax

[email protected]

Personal WatercraftValuation Request Form



Year: Engine:

Model: Model:

Jet Ski Jet Boat

Hover Craft Other: Previous Salvage/Branded Title: Yes No___________________

Deluxe Handle Bars Yes No

Mirrors Yes No 1 2 3 4 5

Cover Yes No Hours 1 2 3 4 5

Fan Tail Yes No 1 2 3 4 5

Ride Plate Yes No

High Flow Impeller Yes No 1 2 3 4 5

High Pro Exhuast Yes No

Exhaust Silencer Yes No 1 2 3 4 5

Intake Grate Yes No

Other Items:



HIN:

Components

Overall

Engine

Body

Seats

Paint

1.888.475.9975 Phone

1.888.475.9935 Fax

Conditions

Interior

Propulsion

Trailer

One Place Two Place Three PlaceTrailer (Circle One):

[email protected]

Type (Circle One):

Options

1.888.475.9975 Phone | 1.888.475.9935 Fax | WWW.VVSI.COM | [email protected]

DIMINISHED VALUE REQUEST FORM

Valuation Methodology (circle one): VVS Proprietary (all states) or 17c (Georgia only)

Office ID Number:_____________________ Claim Rep:_________________________

Company Name:______________________ Return Via (Circle One): FAX or E-MAIL

Company City/State:___________________ Office Fax:_________________________

Office Phone:_________________________ E-Mail:____________________________

Claim Number:________________________ Loss Payee: INSURED CLAIMANT

Type of Loss:__________________________ Name:____________________________

Date of Loss:__________________________ City/State:_________________________

VIN

Condition Rating Guide (Circle One):

1=EXCELLENT 2=ABOVE AVERAGE 3=AVERAGE 4=BELOW AVERAGE 5=POOR

Please attach complete final estimate only Please DO NOT SEND PHOTOS

Additional charges will apply for multiple estimates and/or pictures If vehicle has previous repair history or improvements, attach complete details

Email: [email protected] | FAX: 888.475.9935

http://www.vvsi.com/

Download - VVSi Valuation Request Forms Truck/Tractor Standard Auto ... · Truck/Tractor Valuation Request Form. Office ID Number: Company: Claim Rep Name: Email: Phone / Fax: Calculate Sales

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