UPDATED 02-04-10
SELLING? WERE BUYING
Now purchasing all makes, models and years. Call us 800/257/9634 to find out the cash value of your vehicle.
PICKUP REQUESTED BY:
NEW FORM 8-29-09
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
STATE
LOCATION PHONE #
DATE AVAILABLE FOR PICK-UP
ZIP CODE
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
ALL FIELDS MUST BE COMPLETE! THANK YOU
[HOME] [REBUILDERS I] [REBUILDERS II] [ABOUT US] [PARTS SEARCH] [IMAGE SEARCH] [INS FORM] [CONTACT US] [LOCATION]
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- lemsauto@hotmail.com
NOT RESPONSIBLE FOR TYPOGRAPHICAL ERRORS
