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Diminished Value
Diminished Value Claim Authorization
Customer Name
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Last
Insurance Company
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Claim Number
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Policy Number
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Year / Make / Model
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VIN Number
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Consent
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The customer and Collision Training Institute agree that this Diminished Value Claim Authorization may be executed and delivered by electronic signatures and that the signatures appearing on this Diminished Value Claim Authorization Form have the same force and effect and is the legal equivalent of your manual signature.
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Electronic Signature
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Please enter your full name as it appears on your license or photo ID.
Bill Vallely (President, CTI)
________________________________________________
(Signature)
{name:3.3} {name:3.6}
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