Vehicle Appraisal Form
Provide vehicle details and contact information for appraisal.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Vehicle Identification Number (VIN)
*
Year
*
Make
*
Model
*
Odometer Reading (km or miles)
*
Two sets of keys?
*
Yes
No
Any accidents reported to CarFax?
*
Yes
No
Not sure
Any outstanding damages?
*
Yes
No
Claim started
Tire conditions
*
Worn Out
1
2
3
4
Brand New
5
1 is Worn Out, 5 is Brand New
How many kms on the tires?
*
Windshield condition?
*
Perfect
Some filled chips + cracks
Needs replaced
Do you have a glass policy with your insurance?
*
Yes
No
Two sets of tire?
*
Yes, rubber only
Yes + wheels
No
What maintenance have you completed on the vehicle in the last year?
*
Does your vehicle require any repairs? (select any that apply):
*
Warning lights
ABS System
Engine
Electrical
Transmission
Exhaust
Other, will explain further
No repairs needed
Does your vehicle have extended warranty?
*
Yes
No
Is there a lien (loan) on this vehicle?
*
Yes
No
Please upload a few photos of your vehicle (Recent and clear: exterior, interior, glass, tires...etc)
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