Total Loss Boss Dispute Value Form Auto/Truck

Total Loss Dispute Auto/Truck
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

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Upload Insurance offer/documents*

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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 Auto/Light truck

$50.00 Review 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*

MonthDayYear
Date

Valuation $25

Total Loss Dispute Auto/Truck Product Image

Total Loss Dispute Auto/Truck Includes full market analysis, evidence submission, value rebuttal, and direct negotiation with the insurance company. If you've already paid for a review, that amount is credited

$200.00

Enter coupon

Total

$0.00

Should be Empty: