Loss Of Use Claim Form
Complete our L.O.U Form so that we can best assess your Loss Of Use Claim.
First Name
Last name
Phone Number
Email
VEHICLE Make / Model / Year / Miles
City
State
Date of accident
Do you / did you have a rental vehicle while your vehicle was being repaired?
Yes
No
Only a portion of the time
Date you received your vehicle back (after repairs were completed)?
What is the vehicle's repair cost?
Was the accident your fault?
Yes
No
Is this the first accident your vehicle has been involved in?
Yes
No
Did you suffer any injuries due to the accident?
Yes
No
Did you seek medical attention after the accident?
Yes
No
Have you currently received or accepted any offers for Loss Of Use / Diminished Value?
Yes
No
If you have received an offer, how much was the offer for?
Have you consulted with any other lawyer / law firm regarding this accident?
Yes
No
Upload Drivers License
Select a File
Upload Accident Report / Drivers Exchange of Information
Select a File
Additional Photo
Select a File
What is your vehicle's VIN Number?
I accept this as an introduction of a contact point. I give The Sheldrick Law Firm the consent to contact myself via Phone and/or Email in regards to this accident matter.
Submit