Total Loss Appraisal Order Form If you're ready to move forward with a total loss appraisal dispute, please complete the form below. NameEmail PhoneFile UploadPlease upload the vehicle valuation report provided by the insurer. If you have additional information (pictures, repair bills, upgrades) you'd like to submit, please attach that documentation as well.If your valuation report is in paper format, please fax that document to 678-868-1832. Drop files here or Assignment NotesEnter special instructions or comments to our appraiser.Appraisal RequestedDesk AppraisalDesk Appraisal - RushField AppraisalField Appraisal - RushInspection Location Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total $0.00 Credit CardAmerican ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Terms of Service• The cost of our appraisal report is $150 for desk appraisals and $275 for field appraisals. This includes a report you can submit to your carrier. • There are no refunds for total loss appraisals and we cannot guarantee that the amount in our report will be greater than the adverse appraisal. • On first party claims we can negotiate and settle claims under the appraisal clause for a $100 fee.I have read and agree with the terms of service listed above and I am aware that there are no refunds allowed on appraisals.CommentsThis field is for validation purposes and should be left unchanged.