UPDATED 03-09-2010
IF YOUR SELLING? WERE BUYING ! Click here.
PICKUP REQUESTED BY:
TODAY’S DATE
date of loss:
COMPANY NAME
ADJUSTER NAME
ADJUSTER PHONE #
CLAIM #
VEHICLE OR ITEM TO BE PICKED UP:
YEAR
MAKE
MODEL
COLOR
VIN #
ACV (Required)
LOCATION OF VEHICLE OR ITEM
ADDRESS
CITY AND STATE
ZIP CODE
LOCATION PHONE #
DATE AVAILABLE TO PICK-UP
INSURED OR CUSTOMERS NAME
OWNERS NAME
CONTACT PERSON
IS VEHICLE DRIVEABLE?
IS VEHICLE TOWABLE?
WHERE ARE KEYS LOCATED?
SETTLED ?
CHARGES TO BE PAID?
SPECIAL INSTRUCTIONS
Hours of Operation - Monday-Friday - 7:30-5:00 Saturday - 7:30-12:00
Lems Auto Recyclers ~ 402 Gere Ave.~Doon, IA~51235 1-800-257-9634 or 712-726-3202
www.lemsauto.com E-mail - search@lemsauto.com
not responsible for typographical errors
