ORDER LOSS OF VALUE REPORT

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 information and submit your order to Direct Appraisal.  

We will contact you within 24 hours about your report.  If you have any questions contact the Direct Appraisal office at 972.306.4913 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 PREVIOUS 
ACCIDENT HISTORY
MODEL  VEHICLE CONDITION
SUB MODEL DATE OF LOSS
VIN NUMBER ESTIMATED COST OF REPAIRS
MILEAGE RESPONSIBLE INS. CO.

VEHICLE OPTIONS

    
ENGINE TYPE ENGINE SIZE TRANSMISSION DRIVE
DOORS BED (IF TRUCK) CAB (IF TRUCK)  
 
Hold down "Ctrl" key to select more than one option.
RADIO/ALARMS SEATS COLOR/PAINT TYPE TIRES

ROOF/SUN
 		POWER ACCESSORIES
 OTHER
  

    If you do not  feel your vehicle has been repaired completely and to industry standards, state why?
  

    Any additional comments:
  

I request that Direct Appraisal perform a market evaluation for the purpose of assessing the loss of value on the above vehicle.

I understand that Direct Appraisal will charge a flat fee of $125.00 plus any applicable tax for my evaluation. I understand that my vehicle will not be physically inspected and that all information I have given regarding my vehicle is true to the best of my knowledge. 

I understand that none of the information submitted or discussed should be considered legal advise.

How would you like your report delivered?

 

Direct Appraisal uses EMS for secured transactions.
For more information on EMS services and security see www.emscorporate.com
If you have any problems please contact Direct Appraisal at 972-306-4913

 

 

 

 

 

 

 

 

 

 

 

 

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