CCC Valuescope Basic Claim information Form

Owner's PhoneCCC Valuescope Basic Claim information FormEmailFaxReport RetrievalOther (Specify)MethodCCC Phone 1-800-621-8070 CCC Fax 1-800-621-7070 CCC Email ID NumberClaim NumberAdjr Name (First & Last)Appr Name (First & Last)Insured NameAdjr Contact#Loss ZIP CodeLoss StateCollisionTheftCollisionOtherLoss TypeCoverage codeComprehensiveLiabilityYesNoLeased VehicleYesNo3rd Party ClaimDate of LossExch#Policy # Claim ClassAdjuster ID#PA Appr ID#VINYearMakeModel2DR4 DRHatchbackConvertibleVanBody StyleWagonPickupUtilityTonShort BedCab & ChassisFleetsideFenderside1 Ton3/4 TonLong Bed1012 TurboDiesel34568 Engine SizeCylindersMileage ( UNK If unknown)TransmissionAutomaticS6S5S4S3OD4 WPORoofExterior/Paint/GlassPower OptionsSeatingCS Cloth SeatsEG Electric Glass RoofPS Power SteeringRR Luggage/Roof RackPB Power BrakesLS Leather SeatsES Electric Steel RoofWG WoodgrainPW Power WindowsRL Reclining/ Lounge SeatsOR Skyview RoofWP Rear Window WiperPL Power LocksBS Bucket SeatsSD Dual Power Roofs2T Two Tone PaintSP Power Driver SeatMS Manual Steel RoofD2 deluxe 2 Tone PaintSH Heated Seats (2)RH Rear Heated SeatsMG Manual Glass RoofPC Power Passenger SeatHP Three Stage PaintPA Power Antenna3S Third Row SeatIP Clearcoat PaintFR flip RoofTT T-Top/PanelPM Power Mirrors3P Power Third SeatMP Metallic PaintGT Glass T-Top/PanelR3 Retractable SeatsPT Power

SP Power Driver Seat SH Heated Seats (2) MS Manual Steel Roof D2 Deluxe 2 Tone Paint ... PA Power Antenna 3S Third Row Seat FR Flip Roof IP Clearcoat Paint PM Power Mirrors 3P Power Third Seat TT T-Top/Panel MP Metallic Paint PT Power Trunk Tailgate R3 Retractable Seats GT Glass T …

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  Deluxe, Flip

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