Diminished Value Appraisal Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Year
Make
Model
VIN#
Date of Loss
Miles on the Date of Loss
Upload Pictures Of The Damage and Repair Bill
Browse Files
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Choose a file
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of
Upload Drivers License and or Insurance of The at Fault Party.
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Is this claim with the At-Fault Party or under Underinsured/Uninsured?
Insurance Company
Claim#
Has your vehicle been in a accident before?
Did your vehicle have any Prior Damage?
Do you own, lease or have a loan on your vehicle and if so with who?
Discribe How the Accident Happend.
If you have a police report please upload it.
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I authorize Elektrica will use the information provided on the Diminished Value Appraisal to determine the loss in value of my property. The information is true and correct to the best of my knowledge
Continue
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