Report Retrieval Method s1

PHONE: (800) 621-8070 / In Illinois: (312) CCC-INFO / FAX: (888) 832-1750
* Indicates Required Field
CRV Office ID Number*
Report Retrieval Method* / Email / Fax / Other
Claim Representative Last Name* / Claim Representative First Name*
Claim Representative Email* / Claim Representative Contact Number*
Date of loss (mm/dd/yyyy) * / Claim Number*
Policy Number / Type of Loss* / Collision / Theft / Other
Insured Name* / Insured Phone Number
Claimant Name / Claimant Phone Number
Loss State* / Loss ZIP Code*
VIN:
Year* / Make* / Model*
Class / Sport / Cruiser / Dirt / Enduro / Utility
ATV / Scooter / Moped / Touring / Custom/Chopper Provide details on options/prices/build sheet
Odometer / Engine Displacement
Overall Condition Ratings* / (1) Below Average / (2) Average / (3) Exceptional
Motorcycle Equipment
SAFETY
Anti-Lock Brakes (2)
Driver’s Side Air Bag
Engine Guard Front
Engine Guard Rear
RADIO
AM Radio
FM Radio
Stereo
Dual Radio
Cassette
CD Player
CD Changer/Stacker
Equalizer
Search/Seek
CB Radio
Premium Radio
Satellite Radio
Auxiliary Audio Connection /

Décor

Full Chrome Kit
Price Paid
Fairing
Half Faring
Windshield Only
Plexiglass Fairing
Floor Boards/Highway Boards
Light Bar Upper
Light Bar Lower
Custom Lights
Price Paid

Convenience

Cruise Control
Forward Controls
Intercom
Navigation System
Alarm
Tool Kit / Wheels
Aluminum/Allow Wheels
Custom Wheels
Price Paid
Performance Tires
Chrome Wheels

Seats

Back Rest Rider
Back Rest Passenger
Custom Seats
Price Paid
Heated Seats

Paint

Powdercoat
Custom Paint
Price Paid / Accessories
Headers
Jet Kit
Luggage/Roof Rack
Rigid Saddle Bags
Soft Saddle Bags
Tank Bag
Tank Bra
Travel Trunk
Side Car
Brand
Winch
Highway Pegs
Trailer Hitch
Fog Lights
Custom Exhaust Cost $
Chrome Accessory / Description / Cost $
Description / Cost $
Description / Cost $
Snowmobile Equipment
Hand Warmers / Thumb Warmers / Ski Skins / Pan Protector
Plastic Skis / Carbides / Studs/Cleats / 2 Up Seats
Screen Kit / Silencer / Windshield Bags / Snow Flaps
Electric Start / Reverse / Idler Wheel Kit / Cover
Custom Suspension / Mirrors / Pipes
Custom Motor Works / Cost $ / Short Track / OEM Aftermarket
Long Track / OEM Aftermarket
Temperature Gauges
Jet Ski Equipment
Silencer / Pipes / Covers / Gauges / Mirrors
Trailer VIN
Year / Make / Model
# of Axles / Brakes: / Electric / None
Length ft.
Equipment / Steel / Aluminum / Number of Units Carried
Mounted Spare Tire / Snowmobile Trailer Only / Cap/Cover / Wind Fairing
ADDITIONAL EQUIPMENT (include price if applicable):
ADJUSTMENTS
Pre Tax Adjustment 1 / Add / Deduct
Pre Tax Adjustment 2 / Add / Deduct
Sales Tax % / Deductible
Post Tax Adjustment 1 / Add / Deduct
Post Tax Adjustment 2 / Add / Deduct
Notes