FREE DIMINISHED VALUE CLAIM CHECK
IF YOUR CAR WAS HIT AND IT WASN'T YOUR FAULT, YOU MAY BE OWED MONEY-- EVEN AFTER REPAIRS.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
YEAR, MAKE, MODEL OF YOUR VEHICLE:
*
DATE OF THE ACCIDENT
*
-
Month
-
Day
Year
Date
WAS THE VEHICLE COMPLETELY REPAIRED?
*
NO
YES: COMPLETELY REPAIRED
DATE OF THE COMPLETED REPAIRS
*
-
Month
-
Day
Year
Date
TOTAL COST OF THE REPAIRS
*
PRE-ACCIDENT VALUE: KELLY BLUE BOOK/EDMONDS ($):
*
WHAT STATE DO YOU LIVE IN?
*
CLAIM NUMBER:
*
WAS THE ACCIDENT YOUR FAULT?
*
NO, THE OTHER DRIVER WAS AT FAULT 100%
YES/NOT SURE
WAS THE DRIVER IDENTIFIED?
*
NO
YES, HAS INSURANCE: FILE A CLAIM
YES, NO INSURANCE
DO YOU HAVE A POLICE REPORT:
*
NO
YES
UPLOAD POLICE REPORT:
*
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HOW MANY YEARS AGO DID IT HAPPENED?
*
1
2
3
DO YOU HAVE UNINSURED MOTORIST PROPERTY DAMAGE COVERAGE?
*
NO
YES
I NEED TO CALL AND ASK THE AMOUNT.
How did you here about us?
*
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