Accident Appraisal

Title

First Name

Last Name

Street and number

Additional Address

City

E-mail

Postal Code

Phone Number

Insurance, License plate (person responsible for the accident)

Mileage (can be submitted later)

Further important information:

Day of damage

Time of accident

Unfallbericht

Fahrzeugschein

Fahrzeugschaden

Purpose of Appraisal

Insurance case

Buy / Sell

Other

How would you like us to contact you?

Please call

Via E-Mail

Other

How did you hear about us?

I have taken note of the privacy policy.

I hereby confirm that the information I have provided is true and that I am aware that a vehicle appraisal is only free of charge if I am the injured party or if it is covered by my insurance.

Successfully sent.