Total Loss Boss Dispute Value Form

Total Loss Dispute Value Specialty
Internal Use - Do Not Edit
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Vehicle *
Type Of Loss *
Year/Make/Model*
VIN Number
Vehicle Mileage
Upload Vehicle Photos

Cancelof
Upload Insurance offer/documents*

Cancelof
Optional Notes or Information
CONTRACT FOR APPRAISAL AND NEGOTIATION SERVICES
By signing below, I agree to the following:

1. SERVICES PROVIDED

Total Loss Boss™ will:

Evaluate the fair market value of my vehicle.
Act as my authorized representative in negotiations with my insurance provider.
2. AUTHORIZATION

I grant Total Loss Boss™ full authority to:

Obtain required documentation (estimates, adjuster reports, etc.)
Communicate with the insurance company and its representatives.
Dispute low settlement offers and present valuation support.
3. CLIENT RESPONSIBILITIES

I agree to:

Provide all relevant, accurate claim info and vehicle details.
Notify Total Loss Boss™ of settlement offers or insurer communication.
4. FEES & PAYMENT

I understand this is a non-refundable fee for dispute service.

$25.00 review only Auto/Trucks

$50.00 Review only Specialty

$200 for Auto/Truck
$400 for RV, Marine/Boat, Trailer, or Heavy Equipment
Fee is due upon submission.
By signing, I acknowledge and agree to all terms above.
Signature*

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Date*

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Vehicle Valuation Specialty $50.00Comprehensive valuation review of marine, RV, trailer, or specialty vehicles. We review the total loss evaluation, estimate, photos and any other information you provide for your Specialty vehicle and tell you if it’s worth disputing before you spend more.
$50.00 Quantity

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Total Loss Dispute Value Specialty