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Car Information
Vehicle Year
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
VIN
Miles
Make
Model
Contact Information
Name
First
Last
Email
Phone
Vehicle Condition
Does your vehicle have a “Branded” title?
Yes
No
Cost
Area of Damage?
Did your vehicle have any damage before the recent loss?
Yes
No
Cost
Area of Damage?
Did your vehicle have any unrepaired damage?
Yes
No
Cost
Area of Damage?
Has your vehicle had anything aftermarket added?
Yes
No
Cost
Area of Damage?
Lender Information
If you decided to use Elektrica after getting your free assessment, we will need the following:
Own (no lienholder)
Yes
No
Lienholder (if applicable)
Lease
Yes
No
Make payments to lender?
Yes
No
Rent or borrow?
Rent
Borrow
Neither
For Elektrica to complete its Assessment we will need the following
Elektrica Assessment questionnaire completed
Proof of Ownership (bill of sale or current registration)
Prior Loss Estimates if applicable
Pictures of four corners of the vehicle
Current Picture of the VIN and Odometer
One photo of the repaired area
CONSENT
I authorize Elektrica will use the information provided on the Diminished Value
Assessment to determine the loss in value of my property. The information is true
and correct to the best of my knowledge.
Comments
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