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Automobile Appraisal Request Form

First Name:
Last Name:
Street Address:
 
City:
State:
Nearest Major City:
Zip Code:
Email:
Telephone Number:
Fax Number:
How did you find us?

Location and Owner of Car (if different from above)
Same as above:
First Name:
Last Name:
Street Address:
 
City:
State:
Nearest Major City:
Zip Code:
Email:
Telephone:
Fax Number:

Additional Comments or Special Instructions

Vehicle Information
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle VIN:
Vehicle Plate Number:
Vehicle Color:
You may print the form and fax/mail to:

Polk Associates, LLC
PO Box 720
Ojai, CA 93024
Ph: 805.646.7293
Fax: 805.646.7294