Recreational: Vehicle Information Form

Please fill out the following information completely. To properly evaluate your vehicle, we need to know everything about it. This includes any repair history (type of damages, dollar amount, area of damage, time of loss), any improvements or modifications done to the vehicle (does not include normal or expected maintenance items such as oil changes and tune-ups), any add-ons such as fairings, ground effects, camper tops, stereos. It also includes upgrades or replacement of "wear related items" such as suspension, drive train repairs, major engine work, interior work, etc.

If additional services are required, such as negotiations requiring arbitration or umpire services, these will be available on a case by case basis and are not included in the fees charged for this evaluation service. If these additional services are required, we will expect you to supply documentation at that time which will verify the validity of claims made. This information can be supplied by mail or by fax at that time. This is so we can properly represent you in such matters. Please remember, you are our client, and we will work entirely for your benefit within all acceptable legal and ethical boundaries. All information supplied to us is kept private and secure. Release of this information will only be done with your written permission, and then only what pertains to the other parties vested interest. We will not be party to lies and deceptions that reflect on you, or on the integrity of our company.

SPECIAL NOTE: If this is for insurance purposes, please note that depending on your insurer and the policy, some items are not covered. Different companies do not allow specialty items or add-on items. Some companies cover only basic factory installed items, and do not cover "Dealer Installed" or some optional "Factory equipment" designed for Sport or Appearance Kits. We can not accept any responsibility for these cases, or deviations that pertain to policy coverage, and/or their acceptance by insurers. Our appraisal of value of your vehicle will be based solely on the information that you supply us. Therefore, we must assume that the information you give us is correct and can be backed by receipts, invoices, repair orders, etc., which may be required by other parties to verify this report. We are taking your supplied information at face value. We have no way to verify if the information is correct and/or current to this vehicle and the condition(s) you are reporting to us.

Please fill out one form for each vehicle you wish to have evaluated. We can not do multiple vehicles off the same worksheet.

CLIENT INFORMATION:

Owner's Name: Phone Number w/area code:

Address: City & State:

Zip Code: Fax Number (if available): E-Mail:

PAYMENT INFORMATION:

You are a current client, with an account with us? YES NO
Account Name:
Your Name: Your Account ID:
Office Name/Branch (if applicable)
Your email address:

I do not have an account with you. I am a private person, or new company, and I understand that payment must be completed BEFORE any work is done.

By checking this box you agree that you understand the terms and conditions under which this report is being prepared for you. You further agree that you understand the payment process, and agree that AIS (Auto Inspection Service) is not responsible for any results, other than that these facts we produce are correct as represented and based solely on the accuracy of the information supplied by you. We can not guarantee that the resulting facts produced will be in agreeance with your impressions, opinions, or personal beliefs regarding the value of your property. Our responsibility is to provide an objective and honest appraisal based on the information supplied by you. Our findings are based on our extensive experience and available databases at the time of this report. We guarantee, based on the information supplied, that this report is accurate and correct in our professional opinion and is not coerced, ineffective, or deficient... nor is it deceptive, illegal, or unethical in it's preparation and filing.

I, (your name here) agree to the above statement, and affirm that this information is correct to the best of my abilities.

If any of the information I have supplied is incorrect, misleading, deceptive, false, and/or inaccurate, I agree to hold harmless AIS and it's employee's and accept full responsibility for the information and for full payment in good faith for services rendered on my behalf by AIS (Auto Inspection Service). (please check this box, it is required to process your report)

We will email you back a copy of the information page, as we receive it, for confirmation and as a receipt/invoice for your records within 24 hours. If you have any questions, please feel free to contact us by E-mail anytime.

VEHICLE INFORMATION:

Complete VIN (Vehicle Identification Number) on 1980 and newer cars/vehicles, the number is 17 digits, older cars/vehicles have a smaller sequence of numbers. You can find it on the driver's side of the dash, face of the driver's door, under the hood on the cowl, boat transom, trailer tongues, or on the vehicle registration. We must have this number, correctly filled out, to identify your vehicle. This is true of cars, trucks, boats, trailers, and recreational vehicles. It is a combination of numbers and letters, so include all.

Fill out this information for all types of vehicle, cars, trucks, marine, and recreational vehicles. Some information may apply, some may not.... we will decide as applicable. Make sure that the information is filled out completely in the applicable areas below for each type of vehicle. WE NEED ALL INFO PLEASE... IF IN DOUBT, FILL IT OUT.

**********GENERAL INFO ALL VEHICLES AS APPLICABLE

Year: Make: Model: Current Mileage:
Body Style: Van Motorcycle Recreational
If applicable, check accordingly: 1/2 Ton 3/4 Ton 1 Ton 2 W/D 4 W/D

Engine Detail: Size Cylinders 3 cyl. 4 cyl. 5 cyl. 6 cyl. 8 cyl. 12 cyl.
Turbo Diesel
Transmission: Auto 3 spd 4 spd 5 spd 6 spd
Over Drive: yes no

Power Options: Pwr Steering Pwr Brakes Pwr Windows Pwr Locks
Pwr Drive Seat Pwr Pass Seat

Radio: AM AM/FM Stereo Cassette CD CD Changer Seek/Scan
8 Track CB Equalizer Type of Antenna

Decor/Convenience: A/C Rear Defogger Tilt Wheel Cruise Control
Cloth Seats Leather Seats 4 Whl Disc Brakes Telescopic Wheel
Auto Load Level 3rd Seat (wagons only) 8 passenger
12 passenger Dual A/C

Wheel Options: Aluminum Alloy Locking Wire Spkd Aluminum
Styled Steel Wire Wire Cover

Roof Options: Vinyl Cabriolet Elec Steel Elec Glass
Manual Steel Manual Glass Convertible
T-Tops Glass T-Tops Roof Rack

**********ADDITIONAL ITEMS

Step Bumper Sliding Back Glass Auxiliary Fuel Tank Two Tone Paint
Custom Paint Metallic Paint Tinted Glass Deep Tinted Glass
Soft Top Hard Top Fog Lights Driving Lamps Running Board
Removable Bed Liner Sprayed Bed Liner Chrome Bed Rails Tool Rack
Headache Rack Roll Bar Trailering Package Trans Cooler Oil Cooler
Permanent Tool Box Grill Guard (plain) Chrome Guard Positraction
Dual Rear Wheels Wood Grain Side Moldings Bucket Seats
Intermittent Wipers Power Mirrors Power Trunk Rear Window Wiper
Reclining Seats 2 wheel ABS 4 wheel ABS

Other items:
General Condition of Vehicle:

**********MOTORCYCLES

Headers Full Fairing Plexi Fairing Custom Seat Saddle Bags
Travel Trunk Engine Guard Back Rest Cruise Control Luggage Rack
(for other items, check above as applicable, ie. Radio)

Other items:
General Condition of Vehicle:

**********RECREATIONAL VEHICLE

Year Make Model
Type: Conversion Van Camper Van Mini Motorhome Class A
5th Wheel Travel Trailer Camper Other if other, what kind?

Additional Equipment, not covered previously in form: TV Type: VCR DVD DISH

Conversion Vans only: Standard Van Deluxe Van Super Deluxe
Regular Roof High Top

Mini and Class A Motor Homes only: Chassis Year Chassis Mfg.
Chassis Model Length Floor Plan
Full Kitchen yes no Full Bath yes no Generator KW
Awning type Length

Other items
Overall Condition of vehicle

**********Refurbishments

Please list below any thing that has been done to improve the condition of the vehicle. We have added an area for you to include things that we may not have covered previously.

Transmission Purchase Date Mileage @ purchase, if known

Engine Purchase Date Purchase Price Mileage @ purchase, if known

Tires Purchase Price Number of tires purchased
Wear on tires (light-9 to 11/32) (medium-4 to 8/32) (heavy-1 to 3/32)

Paint Refinished on Date Refinish Purchase Price
Basic Refinish Factory Quality Refinish Custom Refinish

Camper Shell Purchase Date Purchase Price

Interior Refurbish Date Purchase Price
Interior Type: Cloth Vinyl Leather

Carpet Kit Installed on Date Purchase Price

Special Wheels Purchase Date Purchase Price

Vehicle Restoration Date Restoration Price
************Level of restoration done

Other items and equipment installed or upgraded. Please use the above examples when entering the information. Include the purchase date, the purchase price, and description of the work done. Remember, you should have verifiable records of the work done for proper documentation. DO NOT INCLUDE general maintenance items such as oil changes, tune ups, and other minor repairs. These items do not add to the value of the vehicle, it is the lack of proper maintenance is a factor that takes away from the value of the vehicle.

**********PRIOR REPAIR HISTORY

Please show here any prior losses regarding collision damage, flood, fire, or theft damages suffered. Please indicate the area and type of loss, extent or depth of damages suffered, date of loss, and dollar amount of repairs done.

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