Download - Specialty Valuations, Specialty Vehicles, Special Service - VALU … · 2019. 6. 4. · (855)324-5465: Customer Claim Number: Customer Reference Loss Date: ... Owner Name Owner Phone:

Body Type Axle Configuration GVWR Overall ConditionExcellent Above Avg Average Below Avg Poor

Claim Information

VALU-RITE Request Form Non-Commercial Trailer

Email to [email protected] Enter Online at www.dcisolution.com

Fax to (855)324-5465

Customer Claim Number Customer Reference Loss Date Type of Loss Prior Damage/Other Deductions

TheftFloodFireCollision

Claim RepCompany Claim Rep Name Claim Rep Email Claim Rep Phone

Owner/InsuredOwner Name Owner Phone Owner Email Can DCI contact owner?

Yes No

Owner City Owner State Owner Zip Sales Tax Rate %

Service Requested

Type of Vehicle

Vehicle/Asset

Trailer Types

Tires/Axles

Total Loss ValuationGuaranteed Salvage Bid*Cost AuditFull AppraisalDiminished Value*Collision Estimate

* Salvage Bids and Diminished Value requests require a photo and estimate.

Non-Commercial Trailer

VIN Year Make Model Series

Truck/Trailer Body Options

Comments/Additional Info:

*Please do not include maintenance receipts.

Pictures Receipts* from owner

Paint ConditionExcellent Above Avg Average Below Avg Poor

Exterior Features

DCI Solution 2016 All Rights Reserved 0816

Please include date & cost on upgrades /add-ons.

Trailer Body FeaturesSpare Tire

OtherBarn DoorsRear RampRoll-UpSwing

Side Door (Qty )

Rear Door

Side Rails (Height ) OtherBeavertailSideDrop DownPull OutRamps

Composition Deck LiningAluminumSteelAluminum/SteelOther

AluminumSteelWoodOther

Aluminum

OtherWood

Repainted Date CostYes No

Trailer Body TypeCargo UtilityDump SkidFlatbed Car Hauler Boat Horse ATV/Motorcycle Other

Bumper PullV-NoseGooseneck5th WheelPartialFullTiltEnclosedOpen

Length Width Side Wall Height Capacity Contents Hauled

Interior FeaturesInterior Condition

Excellent Above Avg Average Below Avg Poor

I/S Wheel Type QtyAluminum Steel Alum/Steel

Rear Tire Size Qty Rear Tire Tread RemainingNew 90% 80% 70% 60% 50% 40% 30% 20% 10%

Axle ConfigurationSingle Tandem

Rear Axle Rating

O/S Wheel Type QtyAluminum Steel Alum/Steel

Super Single

Suspension TorsionSpring

Powertrain

AccessoriesE-Track Railgate (Capacity lbs.)Ladder Rack Tarp System

ElectricManual

D-Rings (Qty )Spare Tire

Tongue JackPowerManual

Power Roof Vents (Qty )

Tool Box 1 Tool Box 2Steel Aluminum

Dimensions:

Date/Cost:

Steel Aluminum

Dimensions:

Date/Cost:

* Please put additional tool boxes in Comments/Additional Info Box above.