Specialized Claims Synergy

Delivering Excellence

One Claim At A Time™



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

Diminished Value Request Form

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

Your Name:

Vehicle Owner Name:





Zip Code:

Email Address?:

Claim#(if applicable):

Date of Loss:

Adjuster Name:

Insurance Company:

Vehicle Year:

Vehicle Make:

Vehicle Model:

Vehicle VIN:

Primary Area of Impact:

Final Repair Cost: $


Repair Quality:

First Accident for Vehicle:

All Repairs Complete?:

Overall Vehicle Condition:

Inspection Needed?

Additional Information:

Please upload a ZIP FOLDER with: Final Repair Estimate(mandatory); any photos of vehicle before loss(if available); any photos with accident damage(if available); any photos after repairs(if available); Carfax report if ran/available: