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Get American Freedom Physical Damage Inspection/ Mechanical Statement Report

American Freedom Insurance Company PHYSICAL DAMAGE INSPECTION/ MECHANICAL STATEMENT REPORT 559 W. Golf Rd. Arlington Heights IL 60005 Named Insured Policy No. Address Producer City State Zip VEHICLE INFORMATION Year Make/Model Doors VIN Color Odometer FOR PHYSICAL DAMAGE COVERAGE conduct a visual inspection of the vehicle and indicate on the illustration the areas where any damage exists such as dents holes chips scratches rust etc. Give special attention to bumpers windshields and condition of paint. Describe any present damage in the space provided below. Must be signed by a certified mechanic shop MECHANICAL INFORMATION Tire condition good Brakes working properly Headlights working Tail lights working Engine in good condition Yes ACCESSORIES AND OPTIONAL EQUIPMENT No Air Conditioner Anti-Theft Device Automatic Transmission Bucket Seats CB Radio Custom Wheels Customized Body Heated Seats Leather Seats Navigation System Power Seats Power Steering/Brakes Power Windows Radio AM/FM Stereo Cassette CD Player Special Packages Special Tires Sunroof Tinted Glass Vinyl Top/Special Roof Aftermarket Items please list Name of shop Inspected by Date. Arlington Heights IL 60005 Named Insured Policy No* Address Producer City State Zip VEHICLE INFORMATION Year Make/Model Doors VIN Color Odometer FOR PHYSICAL DAMAGE COVERAGE conduct a visual inspection of the vehicle and indicate on the illustration the areas where any damage exists such as dents holes chips scratches rust etc* Give special attention to bumpers windshields and condition of paint* Describe any present damage in the space provided below. Must be signed by a certified mechanic shop MECHANICAL INFORMATION Tire condition good Brakes working properly Headlights working Tail lights working Engine in good condition Yes ACCESSORIES AND OPTIONAL EQUIPMENT No Air Conditioner Anti-Theft Device Automatic Transmission Bucket Seats CB Radio Custom Wheels Customized Body Heated Seats Leather Seats Navigation System Power Seats Power Steering/Brakes Power Windows Radio AM/FM Stereo Cassette CD Player Special Packages Special Tires Sunroof Tinted Glass Vinyl Top/Special Roof Aftermarket Items please list Name of shop Inspected by Date. .

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