ACTUAL CASH VALUE ORDER FORM

To receive an appraisal from us, please fill out the questionnaire below and answer our questions to the best of your

ability. If you have additional supporting documents that you feel will affect the cash value of your vehicle, please

email those to us as well.

Document submission email: docs@carappraisal.us

Payment Page: http://carappraisalclaims.com/services-pricing/ (Desk Appraisals are $150)

Where would you like your final appraisal report to be sent to?

Option 1 – Email (enter email address)

Option 2- US Mail (enter mailing address)

Option 3 – Fax (enter fax#)

QUESTIONNAIRE:

Today's Date

Vehicle Owner

Phone Number

Vehicle Location (City and State)

Vehicle Identification Number (VIN#)

Series of Sub-model (LX, EX, SLT etc…)

Drivetrain (2WD or 4WD)

Engine (Cylinder Count and Fuel type) Example: 4 Cyl - Gas

Options and Equipment Example: leather seats, sunroof, alloys etc…

Odometer Reading

Is the title salvage or branded?

Previous Accidents?

Please describe the previous accident(s).

Does the vehicle start and run as it

should?

Mechanical problems if any

Overall Condition (10 =Like New, 1= very rough) 1 2 3 4 5 6 7 8 9 10

Tire Tread %

Smoker’s Car

Date of Last Oil Change

Please describe this vehicle in your own

words:

Note: If this is for an Insurance claim, please send us

the repair estimate or the vehicle valuation report

issued by the carrier.

Insurance Carrier

Claim #

Date of Loss:

Pictures Requested (optional):

Odometer (Mileage)

VIN Sticker

Right Side

Left Side

Front

Rear

Dashboard

Engine

Tires and Wheels

Equipment or Accessories