| Owner
Name |
* |
| E-Mail
Address |
* |
| Refer |
|
| Street
Address |
|
| City,
State, Zip |
,
|
| Phone |
* |
| Date |
* |
| Reason
for Appraisal |
* |
| Insurance
Company |
|
| Vehicle
Make |
|
| Vehicle
Year |
|
| Vehicle
Model |
|
| Body
Type |
|
| Mileage |
|
| License
Number |
|
| State |
|
| Country |
|
| Color |
|
| VIN |
|
| Condition |
(hold the CTRL key
to select Multiple items) |
| Body |
|
| Doors |
|
| Hood |
|
| Trunk |
|
| Top |
|
| Sunroof
Type |
|
| Sunroof
Condition |
|
| Vehicle
Paint |
|
| Vehicle
Trim |
|
| Vehicle
Glass |
|
| Mirrors |
|
| Mirror
Locations |
|
| Lights |
|
| Fog
Lights |
|
| Light
Check |
|
| Engine
Operation |
|
| Engine
Type |
|
| Fuel
System |
|
| Engine
Size |
|
| Cylinders |
|
| Valves |
|
| Engine
Electric Systems |
|
| Belts
and Hoses |
|
| Engine
Compartment Condition |
|
| Suspension |
|
| Shock
Condition |
|
| Shock
Type |
|
| Brake
Condition |
|
| Brake
Line Type |
|
| Brake
Type |
(hold the CTRL key
to select Multiple items) |
| Brake
Options |
(hold the CTRL key
to select Multiple items) |
| Custom
Brake Type (if applicable) |
|
| Steering
Condition |
|
| Steering
Options |
(hold the CTRL key
to select Multiple items) |
| Tire
Wear, Percentage Remaining |
Right Front |
| Tire
Wear, Percentage Remaining |
Left Front |
| Tire
Wear, Percentage Remaining |
Right Rear |
| Tire
Wear, Percentage Remaining |
Left Rear |
| Tire
Manufacturer and Type |
|
| Tire
Misc |
(hold the CTRL key
to select Multiple items) |
| Wheel
Type |
|
| Wheel
Finish |
|
| Custom
Wheel Brand (if applicable) |
|
| Transmission
Type |
|
| Transmission
Speeds |
|
| Transmission
Condition |
|
| Clutch
Type |
|
| Clutch
Condition |
|
| Interior
Condition Pre-Loss |
|
| Instrument
Panel |
|
| Controls |
|
| Headliner |
|
| Front
Upholstery |
|
| Front
Upholstery Type |
|
| Front
Upholstery Condition |
|
| Rear
Upholstery Type |
|
| Rear
Upholstery Condition |
|
| Door
Upholstery |
|
| Door
Upholstery Condition |
|
| Kick
Panel Upholstery |
|
| Kick
Panel Upholstery Condition |
|
| Carpet,
Front |
|
| Carpet,
Front Condition |
|
| Carpet,
Rear |
|
| Carpet,
Rear Condition |
|
| Window
Operation |
|
| Window
Type |
|
| Door
Operation |
|
| Radio
Operation |
|
| Radio
Type |
|
| Air
Conditioning |
|
| Recent
Engine Repairs |
|
| Recent
Engine Repair Year |
|
| Recent
Engine Repair Miles |
|
| Recent
Transmission Repair Year |
|
| Recent
Transmission Repair Miles |
|
| Recent
Clutch Repair Year |
|
| Recent
Clutch Repair Miles |
|
| Recent
Tires Repair Year |
|
| Recent
Tires Repair Miles |
|
| Recent
Paint & Body Repair Year |
|
| Recent
Paint & Body Repair Miles |
|
| Recent
Upholstery Repair Year |
|
| Recent
Upholstery Repair Miles |
|
| Recent
Convertible Top Repair Year |
|
| Recent
Convertible Top Repair Miles |
|
| Recent
Suspension Repair Year |
|
| Recent
Suspension Repair Miles |
|
| |
|
| Overall
condition of vehicle / Any additional info you would like to add |
|
|
Payment
Type |
*
MasterCard
Visa
Amex
Discover
*
|
|
Credit
Card number |
*
Expires:
*
|
|
Card
Holder Name
|
* Billing Zip Code *
|
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submitting this form, please print a copy for your records.
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Our
Fax number is: (805) 482 6798
|