ORDER MARKET VALUE SURVEY

The following information will help 
Direct Appraisal expedite your report and allow us to provide you with the best possible services. 

Please complete the following form and submit your order to Direct Appraisal.  

We will contact you within 24 hours with your report.  If you have any questions contact the Direct Appraisal office at 972.248.2034 or e-mail.
How did you hear about 
Direct Appraisal?
Has the vehicle been involved 
in an accident?
Was the Accident your fault?
Has the vehicle been repaired?
Are you satisfied with 
the repairs?

CUSTOMER  INFORMATION

    
FIRST NAME FAX
LAST NAME ADDRESS
PHONE ADDRESS
WK/CELL PHONE CITY

E-MAIL

STATE/ZIP

VEHICLE INFORMATION

    
YEAR PURCHASED VEHICLE
MAKE ACCIDENT HISTORY
MODEL  VEHICLE CONDITION
SUB MODEL DATE OF LOSS
VIN NUMBER ESTIMATED COST OF REPAIRS
MILEAGE INSURANCE COVERAGE

VEHICLE OPTIONS

    
ENGINE TYPE ENGINE SIZE TRANSMISSION DRIVE
Hold down "Ctrl" key to select more than one option.
RADIO/ALARMS SEATS COLOR/PAINT TYPE TIRES


 If you do not  feel your vehicle has been repaired completely and to industry standards state why?
 Any additional comments: