Specialized Claims Synergy

Delivering Excellence

One Claim At A Time™

TM

    855-735-9727

                                                       Specialized Claims Synergy © 2011-2018. All rights reserved.

Automatic


Manual 3 Speed


Manual 5 Speed


Paddle Shift/Automatic


Manual


Manual 4 Speed


Manual 6 Speed


Your Name

Your Telephone#

Extension

Your Email

Vehicle Type

Additional vehicle options, remarks, other vehicle conditions ,requests, etc. :

Year

     Make

Model

    VIN

License Plate

Color

Odometer

Vehicle Address

Vehicle City

Vehicle State

Claim#

(if Applicable)

Standard Auto and Classic Car Valuation Form

Vehicle Zip

Other

3 Cylinder

4 Cylinder

6 Cylinder

8 Cylinder

10 Cylinder

 Diesel

Turbo

Other

Coupe/2 Door


Sedan/ 4 Door


Hatchback


3 Door


Truck


Mini Van


Trailer


Wagon


Short Bed


Long Bed


½ Ton


¾ Ton


1 Ton


Pickup


Van


Utility


Convertible


Other


Premium

Stock

Am/Fm Stereo

Cassette

CD

CD Changer

JVC Speakers

BOSE Speakers

Sony Speakers

Premium Speakers

Woofers

Equalizers

Amplifier

On-Star

Nav System

Touch Screen

LCD Screen

Headrest Screen

USB Input

Bluetooth

RCA Input

MP3 Input

Apple Play

Google Play

Sirius Radio

Audio/Navigation Other:

Backup Camera

Camera Mirror

Camera Screen

Front Bumper Sensors

Rear Bumper Sensors

Side Sensors

Front Airbags

Side Airbags

Roof Airbags

Accident Avoidance System


Side Accident Sensors


Auto Safety Braking


Anti-Lock Brakes


Roll Cage


Traction Control


Chrome Moldings

Body Side Moldings

Standard Moldings

Aftermarket Moldings

Pen Striping

Painted Stripes

Graphics

Flames

Roof Rack

Spot Lamp

Running Board


Power Running Boards

Raised Hood

Carbon Fiber Hood

Winch

Tool B ox

Bed Liner

Spray Bed Liner

Camper Shell

Tonneau Cover

Tow Package

5th Wheel


Tinted Windows

Convertible Top

Power Convertible

T-Top

Hard Top

Flip Top

Detachable Top

Vinyl Top

Cabaret Top

Step Bumper

Grille Guard

Stone Guard Protection

Hitch

Power Running Board

Towing Camera

Bed Rails

Spoiler

VIN Etching

Electric Car

Flex Fuel

Hybrid Car

Other:

Cloth Seats

Leather Seats

Vinyl Seats


Rubber Flooring

Carpet Flooring

Bucket Seats

Captain Seats

Bench Seats

Reclining Seats

Leather Dash

Wood Trim

Other:

Climate Control

Heated Seats

Cooled Seats

Tilt Steering

Cruise Control

All Wheel Drive

4 Wheel Drive

Power Seats

Power Lock

Power Gate

Power Slide Door

Removable Third Seat

Power Antenna

Automatic Headlamps

Auto Start

Remote Control Fob

Security Alarm

Theft Prevention

Power Mirrors

Self Parking

Self Backing

Flex Fuel

Power Pedal Adjust

Overhead Console

Hidden Compartment

Engine Heater

8 Passenger

Halogen Lights

Xenon Lights

Headlamp Washers

Flip Headlamps

Tire Pressure Sensors

Inflatable Seat Belts

Adaptive Headlights

Conversion Package

Keyless Entry

Wi-Fi

Voice Control

Wireless Charging

Heads Up Display



Hybrid

Single Stage

Two Stage

Three Stage/Pearl

Lacquer Finish


Original Classic Finish

Matte Finish

Mirrored Finish

Metallic

Painted Graphics

Primer Finish

Clear Coat


Decals

Environmental Protection

Stone Guard

Rust Protection

 

Steel Wheels

Wheel Covers

Aluminum Wheels

Chrome Wheels


Styled Wheels

Wire Wheels

Locking Wheels

Clad Wheels

Premium  Wheels

Aftermarket Wheels

Factor Wheels

Wheel Caps

18 Inch Wheels

20 Inch Wheels

Oversized Wheels

Premium Tires

Excellent                    Very Good                    Good                   Average                    Fair                    Poor                    Needs Replacement

Excellent                    Very Good                    Good                    Average                    Fair                    Poor                   Needs Replacement     

Excellent                    Very Good                    Good                    Average                    Fair                    Poor                    Needs Replacement

Excellent                    Very Good                    Good                    Average                   Fair                   Poor                    Needs Replacement

Excellent                    Very Good                    Good                    Average                    Fair                    Poor                    Needs Replacement

Excellent                    Very Good                    Good                   Average                    Fair                    Poor                    Needs Replacement

Excellent                    Very Good                    Good                    Average                  Fair                     Poor                    Needs Replacement

Transmission

Vehicle Engine

Vehicle Body

Audio/Navigation

Safety

Exterior Options

Interior

Additional Options

Paint/ Finish

Wheels

Body/ Exterior Rating

Engine Rating

Transmission Rating

Interior Rating

Paint Rating

Glass Rating

Tire Rating

* Our staff will call you within 24 business hours after completion of this form. Fee collected at time of call.