Customer Contract and Information form for Purchasing Individual Auto Diminished Value Report

Vehicle Information

Payment Information

Choose Payment Method Below: Cost of single report is $225.00

By completing this form and returning to Claims-Plus, Inc. I agree to have charges placed upon my credit card in the amount listed above, when credit card box has been marked. I also certify that all the information given above is true to the best of my knowledge. I agree that Claims-Plus, Inc will not be responsible or liable for any amounts collected or not collected from the responsible party. The report I am purchasing is derived from research completed from information from industry sources commonly found at the time of research. The amount of lost value is the opinion of the researcher based upon different sources of information at that time. Claims-Plus will not be responsible or liable for any wrongful information received from customer. This report is issued without bias to either party and is the sole opinion of Claims-Plus, Inc.