888.475.9975 phone 888.475.9935 fax www.v-v-s.com web firstname.lastname@example.org file submit and inquiries Motorcycle Electronic Valuation Request Form Instructions: Within the Electronic VRF use the Tab key NOT the return/enter key. To indicate if an option is present and a check box is used either click the box with your mouse or Tab to it and hit X or the space bar. If unable to fill out any particular section try going to prior section by hitting Shift-Tab and then returning by hitting Tab. Within freeform fields abbreviate if needed. When completed “Save As” your Claim Number or Insured Name, note where file was saved and submit as an attachment to email@example.com. Attach any other pertinent document with submission. Call 888.475.9975 for assistance. Office ID or Name and City Office Phone Number Claim Rep Name Office Fax Number Date of Loss Appraiser Company Name Appraiser Name Owners Name City Owners Phone (required if no zip) VVS Request # if already exists Claim Number Email Address Type of Loss Appraiser Phone ACV Amount Contact Name State Owners Zip Code Vehicle Information VIN Year Make Model Name Model Number Style Select One Description of Motorcycle (if needed): Fairing Travel Trunk Lugg Rack Back Rest Cruise Eng Guards CB Radio Alarm Lightbar Odometer Other Items: Factory Equipment Oil Cooler Intercom Tow Package Windshield Trailer Saddle Bags Gun Rack (ATV) Radio None Custom Equipment Exhaust Header Jet Kit Custom Exhaust Custom Paint Performance Tires Custom Wheels Custom Seat Chrome None Side Car (Mfgr) Forward Controls Motorcycle Conditions Body Cond 3 Average Front Tire Wear Remaining Engine Cond 3 Average Refurbishments: Type of Refurb Paint Cond % Trans Cond 3 Average Glass Cond Rear Tire Wear Remaining 3 Average Date and/or Cost of Refurb 3 Average % Indicate here if a call prior to valuation being completed is needed or any other comments -Thank you: When completed “Save As” your Claim Number or Insured Name, note where file was saved and submit as an attachment to firstname.lastname@example.org.