Virtual Appraisal Form
Get Top Dollar for Your Wheelchair Van Today!
Contact Information
Your Name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How would you like to be contacted ?
*
Email
Phone
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Vehicle Information
Ownership and Title Information
Vehicle Year
*
Vehicle Make
*
Vehicle Model
*
Vehicle Identification Number (VIN)
*
Conversion Type
*
Side Entry
Rear Entry
No Conversion
Mileage
*
Registered of Owner's Name
*
First Name
Middle Name
Last Name
Registered of Owner's Name #2 (if applicable)
First Name
Middle Name
Last Name
Is this vehicle currently financed?
*
No
Yes
Name of finance company ? (if applicable)
Loan payoff amount ? (if applicable)
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Vehicle History
Has the vehicle been involved in accident ?
*
No
Yes
I don't know
Does the vehicle need service or repairs ?
*
No, the vehicle needs nothing
Yes, I will explain below
I don't know
If Yes, please explain what service or repairs are needed.
Is there any damage to the exterior or interior of the vehicle ?
*
No, the vehicle is in showroom condition
Yes, I will explain below
I don't know
If Yes, please explain what is damaged to the exterior or interior ?
Additional Notes
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Exterior Pictures
(sample pictures included)
Ramp Deployed
*
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Passenger Side Front Corner
*
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Passenger Side Complete
*
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Passenger Side Rear Corner
*
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Driver Side Front Corner
*
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Driver Side Front Complete
*
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Driver Side Rear Corner
*
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Upload Interior Pictures
(sample pictures included)
Driver Seat
*
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Passenger Seat
*
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Rear Seat(s)
*
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Odometer
*
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Vehicle Identification Number (VIN)
*
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Upload Ownership Info
(sample pictures included)
Current Registration
*
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Title
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Loan Payoff (if applicable)
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ID of Registered Owner #1
*
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ID of Registered Owner #2 (if applicable)
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Upload Pictures of Damages
(If Applicable - sample pictures included)
Pictures of Damages (if applicable)
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Asking Price
What price did you have in mind for your vehicle ?
*
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