Report Retrieval Method



*Office ID Number FORMTEXT ?????*Claim Number FORMTEXT ?????Adjuster ID# (if applicable) FORMTEXT ?????Company Name FORMTEXT ?????*Adjr Name (First & Last) FORMTEXT ?????Appr Name (First & Last) FORMTEXT ?????Adjr Contact# FORMTEXT ?????*Insured’s Name FORMTEXT ?????Owner’s Name FORMTEXT ?????Owner’s Phone FORMTEXT ?????*Loss ZIP Code FORMTEXT ????? Loss State FORMTEXT ?????*Loss Type FORMCHECKBOX Other FORMCHECKBOX TheftCoverage code FORMCHECKBOX Collision FORMCHECKBOX Comprehensive FORMCHECKBOX Liability FORMCHECKBOX Other3rd Party Claim FORMCHECKBOX Yes FORMCHECKBOX NoLeased Vehicle FORMCHECKBOX Yes FORMCHECKBOX No*Date of Loss FORMTEXT ?????Exch.# Policy # FORMTEXT ?????PA Appr ID# FORMTEXT ?????Claim Class FORMTEXT ?????*VIN FORMTEXT ?????*Year FORMTEXT ?????*Make FORMTEXT ?????*Model FORMTEXT ?????Package 1: FORMTEXT ?????Package 2: FORMTEXT ????Body Style FORMCHECKBOX 2DR FORMCHECKBOX 4DR FORMCHECKBOX Hatchback FORMCHECKBOX Convertible FORMCHECKBOX Wagon FORMCHECKBOX Pickup FORMCHECKBOX Van FORMCHECKBOX Utility FORMCHECKBOX ? Ton FORMCHECKBOX ? Ton FORMCHECKBOX 1 Ton FORMCHECKBOX Short Bed FORMCHECKBOX Long Bed FORMCHECKBOX Cab & Chassis FORMCHECKBOX Fleetside FORMCHECKBOX FendersideEngine Size FORMTEXT ?????Cylinders FORMCHECKBOX 3 FORMCHECKBOX 4 FORMCHECKBOX 5 FORMCHECKBOX 6 FORMCHECKBOX 8 FORMCHECKBOX 10 FORMCHECKBOX 12 FORMCHECKBOX Turbo FORMCHECKBOX Diesel*Mileage (“UNK” if unknown) FORMTEXT ?????*Transmission FORMCHECKBOX Automatic FORMCHECKBOX Overdrive FORMCHECKBOX S6 FORMCHECKBOX S5 FORMCHECKBOX S4 FORMCHECKBOX S3 FORMCHECKBOX 4WPower Options FORMCHECKBOX PS Power Steering FORMCHECKBOX PB Power Brakes FORMCHECKBOX PW Power Windows FORMCHECKBOX PL Power Locks FORMCHECKBOX PM Power Mirrors FORMCHECKBOX SP Power Driver Seat FORMCHECKBOX PC Power Passenger Seat FORMCHECKBOX PT Power Trunk/Gate Release FORMCHECKBOX PP Power Adjustable Pedals FORMCHECKBOX PD Power Sliding Door FORMCHECKBOX DP Dual Power Sliding DoorsDécor/Convenience FORMCHECKBOX AC Air Conditioning FORMCHECKBOX CL Climate Control FORMCHECKBOX DA Dual Air Conditioning FORMCHECKBOX TW Tilt Wheel FORMCHECKBOX CC Cruise Control FORMCHECKBOX IW Intermittent Wipers FORMCHECKBOX CN Console/Storage FORMCHECKBOX CO Overhead Console FORMCHECKBOX MM Memory Package FORMCHECKBOX NV Navigation System FORMCHECKBOX EC Entertainment Center FORMCHECKBOX DU Dual Entertainment Center FORMCHECKBOX TL Telescopic Wheel FORMCHECKBOX MC Message Center FORMCHECKBOX GD Home Link FORMCHECKBOX RD Rear Defogger FORMCHECKBOX RJ Remote Starter FORMCHECKBOX WT Wood Interior Trim FORMCHECKBOX KE Keyless Entry FORMCHECKBOX SZ Rear Power SunshadeSeating FORMCHECKBOX CS Cloth Seats FORMCHECKBOX BS Bucket Seats FORMCHECKBOX RL Reclining/Lounge Seats FORMCHECKBOX LS Leather Seats FORMCHECKBOX SH Heated Seats FORMCHECKBOX RH Rear Heated Seats FORMCHECKBOX VB Ventilated Seats FORMCHECKBOX 3S 3rd Row Seat FORMCHECKBOX 3P Power Third Seat FORMCHECKBOX R3 Retractable Seats FORMCHECKBOX 2P 12 Passenger Seating FORMCHECKBOX 5P 15 Passenger Seating FORMCHECKBOX B2 Captain Chairs (2) FORMCHECKBOX B4 Captain Chairs (4) FORMCHECKBOX B6 Captain Chairs (6)Radio FORMCHECKBOX AM AM Radio FORMCHECKBOX FM FM Radio FORMCHECKBOX ST Stereo FORMCHECKBOX SE Search/Seek FORMCHECKBOX CD CD Player FORMCHECKBOX CA Cassette FORMCHECKBOX TQ Steering Wheel Touch Controls FORMCHECKBOX M3 Auxiliary Audio Connection FORMCHECKBOX UR Premium Radio FORMCHECKBOX SK CD Changer/Stacker FORMCHECKBOX XM Satellite Radio FORMCHECKBOX EQ EqualizerWheels FORMCHECKBOX SY Styled Steel Wheels FORMCHECKBOX FC Full Wheel Covers FORMCHECKBOX CY Clad Wheels FORMCHECKBOX AW Aluminum/Alloy Wheels FORMCHECKBOX CJ Chrome Wheels FORMCHECKBOX W2 20” or Larger Wheels FORMCHECKBOX WW Wire Wheels FORMCHECKBOX WC Wire Wheel Covers FORMCHECKBOX KW Locking WheelsRoof FORMCHECKBOX EG Electric Glass Roof FORMCHECKBOX ES Electric Steel Roof FORMCHECKBOX OR Skyview Roof FORMCHECKBOX SD Dual Power Sunroof FORMCHECKBOX MS Manual Steel Roof FORMCHECKBOX MG Manual Glass Roof FORMCHECKBOX FR Flip Roof FORMCHECKBOX TT T-Top/Panel FORMCHECKBOX VP Power Convertible Roof FORMCHECKBOX RM Detachable Roof FORMCHECKBOX VR Vinyl Covered Roof FORMCHECKBOX HT Hard TopSafety/Brakes FORMCHECKBOX AG Driver’s Side Air Bag FORMCHECKBOX RG Passenger Air Bag FORMCHECKBOX XG Front Side Impact Air Bags FORMCHECKBOX ZG Rear Side Impact Air Bags FORMCHECKBOX DG Head/Curtain Air Bags FORMCHECKBOX DB 4-Wheel Disc Brakes FORMCHECKBOX AB Anti-Lock Brakes (4) FORMCHECKBOX A2 Anti-Lock Brakes (2) FORMCHECKBOX TX Traction Control FORMCHECKBOX T1 Stability Control FORMCHECKBOX PO Positraction FORMCHECKBOX C2 Communications System FORMCHECKBOX PJ Parking Sensors FORMCHECKBOX PX Backup Camera W/ Sensors FORMCHECKBOX TD Alarm FORMCHECKBOX HF Hands Free Device FORMCHECKBOX XE Xenon Headlamps FORMCHECKBOX HU Heads Up Display FORMCHECKBOX IC Intelligent Cruise FORMCHECKBOX DV Blind Spot Detection FORMCHECKBOX LN Lane Departure Warning FORMCHECKBOX VZ Night Vision FORMCHECKBOX RB Roll BarExterior/Paint/Glass FORMCHECKBOX DM Dual Mirrors FORMCHECKBOX HM Heated Mirrors FORMCHECKBOX BN Body Side Moldings FORMCHECKBOX TG Tinted Glass FORMCHECKBOX AF Aftermarket Film Tint FORMCHECKBOX DT Privacy Glass FORMCHECKBOX WP Rear Window Wiper FORMCHECKBOX FL Fog Lamps FORMCHECKBOX RR Luggage/Roof Rack FORMCHECKBOX SL Rear Spoiler FORMCHECKBOX HV Headlamp Washers FORMCHECKBOX MX Signal Integrated Mirrors FORMCHECKBOX WG Wood grain FORMCHECKBOX IP Clear coat Paint FORMCHECKBOX MP Metallic Paint FORMCHECKBOX 2T Two Tone Paint FORMCHECKBOX HP Three Stage PaintOther FORMCHECKBOX SB Rear Step Bumper FORMCHECKBOX TH Trailer Hitch FORMCHECKBOX TP Trailering Package FORMCHECKBOX SW Rear Sliding Window FORMCHECKBOX PG Power Rear Window FORMCHECKBOX BD Running Board/Side Steps FORMCHECKBOX UP Power Retractable Running Boards FORMCHECKBOX BL Bed liner FORMCHECKBOX BY Bed liner (Spray On) FORMCHECKBOX TN Soft Tonneau Cover FORMCHECKBOX TZ Hard Tonneau Cover FORMCHECKBOX CP Deluxe Truck Cap FORMCHECKBOX AR Bed Rails FORMCHECKBOX GG Grill Guard FORMCHECKBOX TB Tool Box (Permanent) FORMCHECKBOX WD Dual Rear Wheels FORMCHECKBOX XT Auxiliary Fuel Tank FORMCHECKBOX EM California Emissions FORMCHECKBOX SG Stone Guard FORMCHECKBOX WI WinchREFURBISHMENTSTransmissionPurchase Price FORMTEXT ?????Mileage FORMTEXT ?????EnginePurchase Price FORMTEXT ?????Mileage FORMTEXT ?????TiresPurchase Price FORMTEXT ?????# of Tires FORMTEXT ?????Paint FORMCHECKBOX Basic FORMCHECKBOX Standard FORMCHECKBOX CustomDate Painted FORMTEXT ?????Purchase Price FORMTEXT ?????InteriorPurchase Price FORMTEXT ?????Date FORMTEXT ????? FORMCHECKBOX Leather FORMCHECKBOX Vinyl FORMCHECKBOX ClothCamper ShellPurchase Price FORMTEXT ?????Date FORMTEXT ?????Carpet KitPurchase Price FORMTEXT ?????Date FORMTEXT ?????Special WheelsPurchase Price FORMTEXT ?????Date FORMTEXT ?????Other Description FORMTEXT ?????Purchase Price FORMTEXT ?????Date FORMTEXT ????? FORMCHECKBOX RestoredRestored Amount FORMTEXT ?????Special Features/Additional Options (XXXX=CALL BACK) FORMTEXT ?????CONDITION RATING: 0=Fair, 1=Private Owner, 2=Dealer, 3=Excellent COMMENTS*Seats FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Carpet FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Dashboard FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Headliner FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Sheet Metal FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Trim FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Paint FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Glass FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Engine FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Transmission FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Front Tires FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????*Rear Tires FORMCHECKBOX 0 FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMTEXT ?????ADJUSTMENTSPre Tax Adjustment 1 FORMTEXT ?????Add FORMTEXT ?????Deduct FORMTEXT ?????Pre Tax Adjustment 2 FORMTEXT ?????Add FORMTEXT ?????Deduct FORMTEXT ?????Sales Tax % FORMTEXT ????? Leave blank if using AutoTaxDeductible FORMTEXT ?????Post Tax Adjustment 1 FORMTEXT ?????Add FORMTEXT ????? Deduct FORMTEXT ?????Post Tax Adjustment 2 FORMTEXT ?????Add FORMTEXT ?????Deduct FORMTEXT ?????PROCESSING INSTRUCTIONS FORMCHECKBOX Expand comparable search (if needed) FORMCHECKBOX Replacement PolicyDealership where purchased (if known) FORMTEXT ?????Report Retrieval Method FORMCHECKBOX Email FORMTEXT ????? FORMCHECKBOX Fax FORMTEXT ????? FORMCHECKBOX Other (Specify) FORMTEXT ?????CCC Phone: 1-800-621-8070CCC Fax: 1-800-621-7070CCC Email: CCCValuescopeRequest@*=Required Field ................
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