Heavy Equipment Claims of Florida

Trailer Submission

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Your Name:

Your Co. Name:

Phone Number:

Insured:

Fax #:

Your
Policy/Claim #:

Email
Address:

Date of Loss:

Date Format: MM/DD/YYYY

Insurance Co. or Salvage Seller:	*
.	.
Other Ins Co. or Salvage Seller:	*

.	.	.
Number of days salvage will be displayed on the site. Select from the drop down list 1 to 30 representing the number of days the salvage will remain on BTS.		Note: 30 Day Max Unless Extended

* If your insurance company or the insurance company you are representing is NOT in the
"Insurance Co" drop down list, select "Other" from the list and type the name of the
insurance company in the "Other Ins Co" text box.

Billing Information *

If the submission is to be billed directly to an Insurance Company,
we must have the following information.

Insurance Company:
.	.
Examiner's Name:
.	.
Examiner's Policy / Claim Number:
.	.
Fax Number:
.	.

*All other billing will be to the individual or company submitting the salvage.

Location of Salvage
City / State / Phone Number

Actual Cash Value of Vehicle	$	NOT Stated Limits
VERY Important

Title Type

Salvage Title Good Title Non-Rebuildable Not Applicable

Year, Make & Model

Full Vehicle Identification Number
Please Check Tenth Digit Against Model Year

Condition:

Good

Fair

Poor

Trailer Size

Length

Width

Suspension:

Spring

Air

Tandem:

Sliding

Fixed

Split

Outer Skin:

Aluminum

Prepainted

Stainless

Steel

FRP

Floor:

Aluminum

Wood

Steel

Doors:

Vent

Curbside

Roadside

Inside:

Kemlite

Plywood

Steel

Ceiling:

Kemlite

Plywood

Steel

Post:

Interior

Exterior

Other

Reefer Unit

Model

HRS:

Dump Body Information

Size Bed/Yds

Frameless
Frame
1/4 Frame
N/A

Grain Door
Barn Door
Coal Door
N/A

Wheel Size

Type

Made Of

Tires
Please Indicate
Any
Damaged Tires

*Denotes
percentage of
tread left
on tire!

LRFO	Damaged	RRFO	Damaged
	Recap		Recap
LRFI	Damaged	RRFI	Damaged
	Recap		Recap
LRRO	Damaged	RRRO	Damaged
	Recap		Recap
LRRI	Damaged	RRRI	Damaged
	Recap		Recap

Please give as much info about
damage as possible. This is VERY important. The more info, the higher the bids!

Example: Rollover. Hood, Cab, Sleeper Damaged. Especially engine, transmission and frame damage!