Vehicle Market Search Order Form

* Indicates Required Fields

Vehicle Owner Information
Name:	* Required	Home Address:	* Required
Primary Phone:	* Required	City:	* Required
Alternate Phone:		State:	* Required
Cell Phone:		Zip:	* RequiredInvalid format.
Email Address:	* RequiredInvalid format.

Vehicle Information
Year:	* Required	Make:	* Required
Model:	* Required	Color:
Series/Package: (i.e.: LS, ES, XLT, GL)		Number of Doors:
VIN Number:	* Required
Engine Size:		# Of Cylinders:
Engine Type:	Gas Diesel Hybrid Turbo	Transmission:	Automatic Manual Speed
Mileage at time of Damage:	* Required	Pre-Damage Vehicle Condition:	* Required
Any Prior Collision?
(If Yes) Give Date
Cost of Repairs $
If the vehicle is less than 1 year old, what was the purchase price $: Cash Price Not including trade allowance, sales tax, warrantees or finance charges

Vehicle Options (Please check all that apply)

POWER ACC
Power Steering
Power Windows
Power Locks
Power Mirrors
Heated Mirrors
Cruise Control
Tilt Steering Whl
Telescope Str Whl
Rear Defroster
Air Conditioning
Dual Air Cond
Climate Control
Dual Zone A/C
Anti-Lock Brakes
Anti-Lock Rear
Driver Airbag
Dual Airbags
Side Airbags
Head Airbags
Rear Side Airbags
Rear Wiper
Remote Trunk Rls
Limited Slip Diff
Locking Diff
Elec. Stability Cntrl
Xenon Headlamps

RADIOS/ALARMS
AM Radio (AM)
AM/FM Stereo
AM/FM Tape
AM/FM Cass/CD
CD Player
CD Changer
InDsh Changer
MP3 Player
Removed
Alarm System
Phone
Remote Starter
Keyless Entry
OnStar
Navigation Sys
Tachometer
Center Console
Overhed Cnsole
Lighted Entry
Rear Entertnmnt
Front Entertnmnt
MP3 Player
Reverse Sensing
Parking Assist
Satellite Radio

SEATS
Power Seat
Dual Pwr Seats
Heated Seats
Htd F&R Seats
Split Bench
Bucket
Cloth/Velour
Leather
Vinyl
2 Captain Chairs
4 Captain Chairs
6 Captain Chairs
2nd Row Capts
2nd Row Bckts
3rd Row Seating

PAINT/TRM/GLASS
Two-Tone
Special Paint
Metallic Paint
Graphics
Tinted Glass
Tinted A/M
Privacy Glass
Sunscreen Glass
Rear Spoiler

ROOF
Landau Roof
Hard top
Luggage Rack
Roll/Light Bar
Pwr Conv Top
Soft Top

SUNROOF
Pwr Solid Sunroof
Manual Solid Snrf
Pwr Glass Mnroof
Pop-Up Roof
T-Top Glass
T-Top Solid
Dual Sunroofs

PICKUP TRUCK/VAN
4x4
Standard Cab
Extra Cab
Crew Cab
Flare Side
Fleet Side
Stepside
Bed Size ‘
Dual Slding Drs
Pwr Sld RH Door
Pwr Sld LH Door
Ladder

BUMPERS
Rear Stp Bumper
Tubular Bumper
Chrome Bumpers
Chrome Stp Bmpr

WHEELS/TIRES
Wire Wheels
Wire Wheel Cvrs
OE Aloy Wheels
AM Alloy Wheels
Chrome OEM
Chrome A/M
Styled Steel
Manual Lock
Wide Tires
Dual Rear Whls
5th Wheel
Trailer/Camper
Trailer Hitch
Running Boards
Spare Tire Carier
Side Steps
Tubular Side Steps
Tonneau Cover
Hrd Tonneau Cvr

OTHER
Grill Guard
Fog Lights
Winch
Canopy
Camper Shell
Bedliner
SprayOn Bedliner
Tool Box
Extra Tank
Hydraulic Liftgate
Lift Kit in
Ground Eff. Pkg
Lowered in
Sld Rear Window
Pwr Sld Rear Wnd
Bra
Air Dam
Rear Heater
Bug Shield
Custom Exhaust
Mini Blinds
Lojack System
Rack Cross Bars
Rear Wnd Dflctr

Notes

Vehicle Market Search Service Agreement

Purpose & Scope: This is an order for vehicle valuation market search services. The scope of this assignment is to establish a set of professional opinions and conclusions as to the fair market value of the subject vehicle just prior to the date of damage. In the course of preparation of this assignment, we may consult with various other companies, organizations, texts, publications and guidebooks. These outside entities include but are not limited to: The National Automobile Dealers Association (NADA), Kelly Blue Book (KBB), Edmunds Auto Values, Black Book, Auto Trader, ADP Autosource, Vehicle Dealers, etc. When information obtained from these outside entities or persons is deemed to be reliable and credible it may be relied upon and become part of the reported information. Client Certification: I certify that the information contained in this form is true and correct to the best of my knowledge and I understand that the accuracy of this information will be relied upon in completing the vehicle valuation. I further 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 contained in any of the reports or other written documents or 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.
RequiredI have read and fully understand both the Service Agreement & the website Terms Of Use